Physician assistants/title

AN ACT Relating to changing the legal title for physician 1
assistants to physician associates, including providing clarification 2
for billing and administrative terminology; amending RCW 18.71A.010, 3
18.71A.030, 18.71A.045, 18.71A.050, 18.71A.060, 18.71A.085, 4
18.71A.090, 18.71A.100, 18.71A.110, 18.71A.120, 18.71A.800, 5
18.71A.810, 18.71A.820, 4.24.240, 7.68.030, 7.70.020, 9.02.110, 6
9.02.130, 9.02.170, 9.41.010, 9.97.020, 10.77.575, 11.130.290, 7
11.130.390, 11.130.615, 18.16.260, 18.50.005, 18.50.115, 18.57.040, 8
18.59.100, 18.71.015, 18.71.030, 18.71.310, 18.71.315, 18.71.360, 9
18.71C.010, 18.79.040, 18.79.060, 18.79.260, 18.79.270, 18.89.020, 10
18.130.020, 18.130.410, 18.134.010, 18.250.010, 18.360.010, 11
28A.210.090, 41.05.177, 41.05.180, 43.70.110, 43.70.442, 43.70.470, 12
46.19.010, 46.19.080, 46.61.506, 46.61.508, 48.20.392, 48.20.393, 13
48.21.225, 48.21.227, 48.43.835, 48.44.325, 48.44.327, 48.46.275, 14
48.46.277, 48.125.200, 51.04.030, 51.08.200, 51.28.010, 51.28.020, 15
51.28.100, 51.36.010, 69.41.030, 69.45.010, 69.50.101, 69.51A.010, 16
70.05.030, 70.05.035, 70.30.061, 70.41.210, 70.41.230, 70.46.020, 17
70.46.031, 70.47.210, 70.54.400, 70.128.120, 70.180.005, 70.180.009, 18
70.180.020, 70.180.030, 70.180.040, 70.225.040, 70.245.010, 19
71.05.020, 71.05.020, 71.05.148, 71.05.154, 71.05.210, 71.05.215, 20
71.05.217, 71.05.230, 71.05.290, 71.05.300, 71.05.585, 71.06.040, 21
71.12.540, 71.32.110, 71.32.140, 71.32.250, 71.32.260, 71.34.020, 22
71.34.020, 71.34.355, 71.34.720, 71.34.730, 71.34.750, 71.34.755, 23
H-2403.1
HOUSE BILL 2127
State of Washington 69th Legislature 2026 Regular Session
By Representatives Marshall, Parshley, Chase, Schmidt, Thomas,
Griffey, and Graham
Prefiled 12/10/25. Read first time 01/12/26. Referred to Committee
on Health Care & Wellness.
p. 1 HB 2127
71.34.770, 71.34.815, 74.09.010, 74.09.328, 74.09.497, 74.09.725, 1
74.42.010, and 74.42.230; amending 2021 c 170 s 1 (uncodified); 2
reenacting and amending RCW 18.71A.020, 46.19.010, 69.41.010, and 3
71.05.660; adding a new section to chapter 41.05 RCW; adding a new 4
section to chapter 48.43 RCW; adding a new section to chapter 74.09 5
RCW; creating a new section; repealing RCW 18.71A.140; providing 6
effective dates; providing contingent effective dates; providing an 7
expiration date; and providing contingent expiration dates.8
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:9
NEW SECTION. Sec. 1. (1) The legislature finds:10
(a) The title "physician assistant" does not adequately reflect 11
the current education, training, or medical role associated with 12
these health care professionals; and 13
(b) The American academy of physician associates supports 14
changing the profession's name to "physician associate" to better 15
represent the responsibilities and collaborative role of these health 16
care professionals in medical care and to clarify their essential 17
contributions within the health care team. 18
(2) The legislature, therefore, intends to: 19
(a) Modernize terminology while ensuring continuity in patient 20
care and administrative processes, in alignment with national 21
standards and professional identity; and 22
(b) Expedite the recognition of the term "physician associate" in 23
professional licensing programs, clinical settings, billing 24
arrangements, and contracting provisions. 25
NEW SECTION. Sec. 2. A new section is added to chapter 41.05 26
RCW to read as follows: 27
(1)(a) The authority shall revise all rules and official 28
materials to change the term "physician assistant" to "physician 29
associate" consistent with the provisions of this act.30
(b) Health plans shall revise all contracts, insurance documents, 31
forms, and other official materials and communications to change the 32
term "physician assistant" to "physician associate" consistent with 33
the provisions of this act. 34
(2) The terms "physician assistant" and "physician associate" may 35
be used interchangeably by the authority, health plans, contractors, 36
health care providers, health care facilities, and employers for all 37
p. 2 HB 2127
statutory, regulatory, credentialing, billing, clinical, and 1
administrative purposes until the transition to the term "physician 2
associate" has been completed. 3
NEW SECTION. Sec. 3. A new section is added to chapter 48.43 4
RCW to read as follows: 5
(1)(a) The commissioner shall revise all rules and official 6
materials to change the term "physician assistant" to "physician 7
associate" consistent with the provisions of this act.8
(b) Carriers shall revise all contracts, insurance documents, 9
forms, and other official materials and communications to change the 10
term "physician assistant" to "physician associate" consistent with 11
the provisions of this act. 12
(2) The terms "physician assistant" and "physician associate" may 13
be used interchangeably by the commissioner, carriers, contractors, 14
health care providers, health care facilities, and employers for all 15
statutory, regulatory, credentialing, billing, clinical, and 16
administrative purposes until the transition to the term "physician 17
associate" has been completed. 18
NEW SECTION. Sec. 4. A new section is added to chapter 74.09 19
RCW to read as follows: 20
(1)(a) The authority shall revise all rules and official 21
materials to change the term "physician assistant" to "physician 22
associate" consistent with the provisions of this act.23
(b) Managed care organizations shall revise all contracts, 24
insurance documents, forms, and other official materials and 25
communications to change the term "physician assistant" to "physician 26
associate" consistent with the provisions of this act.27
(2) The terms "physician assistant" and "physician associate" may 28
be used interchangeably by the authority, managed care organizations, 29
contractors, health care providers, health care facilities, and 30
employers for all statutory, regulatory, credentialing, billing, 31
clinical, and administrative purposes until the transition to the 32
term "physician associate" has been completed. 33
Sec. 5. RCW 18.71A.010 and 2024 c 62 s 2 are each amended to 34
read as follows: 35
The definitions in this section apply throughout this chapter 36
unless the context clearly requires otherwise. 37
p. 3 HB 2127
(1) "Collaboration" means how physician ((assistants)) associates 1
shall interact with, consult with, or refer to a physician or other 2
appropriate member or members of the health care team as indicated by 3
the patient's condition, the education, experience, and competencies 4
of the physician ((assistant)) associate, and the standard of care. 5
The degree of collaboration must be determined by the practice, which 6
may include decisions made by the physician ((assistant's)) 7
associate's employer, group, hospital service, and credentialing and 8
privileging systems of licensed facilities. 9
(2) "Collaboration agreement" means a written agreement that 10
describes the manner in which the physician ((assistant)) associate 11
is supervised by or collaborates with at least one physician and that 12
is signed by the physician ((assistant)) associate and one or more 13
physicians or the physician ((assistant's)) associate's employer.14
(3) "Commission" means the Washington medical commission.15
(4) "Department" means the department of health.16
(5) "Employer" means the scope appropriate clinician, such as a 17
medical director, who is authorized to enter into the collaboration 18
agreement with a physician ((assistant)) associate on behalf of the 19
facility, group, clinic, or other organization that employs the 20
physician ((assistant)) associate. 21
(6) "Participating physician" means a physician that supervises 22
or collaborates with a physician ((assistant)) associate pursuant to 23
a collaboration agreement. 24
(7) "Physician" means a physician licensed under chapter 18.57 or 25
18.71 RCW. 26
(8) "Physician ((assistant)) associate" means a person who is 27
licensed by the commission to practice medicine according to a 28
collaboration agreement with one or more participating physicians and 29
who is academically and clinically prepared to provide health care 30
services and perform diagnostic, therapeutic, preventative, and 31
health maintenance services. 32
(9) "Practice medicine" has the meaning defined in RCW 18.71.011 33
and also includes the practice of osteopathic medicine and surgery as 34
defined in RCW 18.57.001. 35
(10) "Secretary" means the secretary of health or the secretary's 36
designee. 37
Sec. 6. RCW 18.71A.020 and 2024 c 62 s 3 and 2024 c 15 s 3 are 38
each reenacted and amended to read as follows: 39
p. 4 HB 2127
(1) The commission shall adopt rules fixing the qualifications 1
and the educational and training requirements for licensure as a 2
physician ((assistant)) associate or for those enrolled in any 3
physician ((assistant)) associate training program. The requirements 4
shall include completion of an accredited physician ((assistant)) 5
associate training program approved by the commission and within one 6
year successfully take and pass an examination approved by the 7
commission, if the examination tests subjects substantially 8
equivalent to the curriculum of an accredited physician ((assistant)) 9
associate training program. An interim permit may be granted by the 10
department of health for one year provided the applicant meets all 11
other requirements. Physician ((assistants)) associates licensed by 12
the board of medical examiners, or the commission as of July 1, 1999, 13
shall continue to be licensed. 14
(2)(a) The commission shall adopt rules governing the extent to 15
which: 16
(i) Physician ((assistant)) associate students may practice 17
medicine during training; and 18
(ii) Physician ((assistants)) associates may practice after 19
successful completion of a physician ((assistant)) associate training 20
course. 21
(b) Such rules shall provide: 22
(i) That the practice of a physician ((assistant)) associate 23
shall be limited to the performance of those services for which he or 24
she is trained; and 25
(ii) That each physician ((assistant)) associate shall practice 26
medicine only under the terms of one or more collaboration 27
agreements, each signed by the physician ((assistant)) associate and 28
one or more physicians licensed in this state or the physician 29
((assistant's)) associate's employer. A collaboration agreement may 30
be signed electronically using a method for electronic signatures 31
approved by the commission. 32
(3) Applicants for licensure shall file an application with the 33
commission on a form prepared by the secretary with the approval of 34
the commission, detailing the education, training, and experience of 35
the physician ((assistant)) associate and such other information as 36
the commission may require. The application shall be accompanied by a 37
fee determined by the secretary as provided in RCW 43.70.250 and 38
43.70.280. A surcharge of $70 per year shall be charged on each 39
license renewal or issuance of a new license to be collected by the 40
p. 5 HB 2127
department and deposited into the impaired physician account for 1
physician ((assistant)) associate participation in the physician 2
health program. Each applicant shall furnish proof satisfactory to 3
the commission of the following: 4
(a) That the applicant has completed an accredited physician 5
((assistant)) associate program approved by the commission and is 6
eligible to take the examination approved by the commission;7
(b) That the applicant is of good moral character; and8
(c) That the applicant is physically and mentally capable of 9
practicing medicine as a physician ((assistant)) associate with 10
reasonable skill and safety. The commission may require an applicant 11
to submit to such examination or examinations as it deems necessary 12
to determine an applicant's physical or mental capability, or both, 13
to safely practice as a physician ((assistant)) associate.14
(4)(a) The commission may approve, deny, or take other 15
disciplinary action upon the application for license as provided in 16
the Uniform Disciplinary Act, chapter 18.130 RCW. 17
(b) The license shall be renewed as determined under RCW 18
43.70.250 and 43.70.280. The commission shall request licensees to 19
submit information about their current professional practice at the 20
time of license renewal and licensees must provide the information 21
requested. This information may include practice setting, medical 22
specialty, or other relevant data determined by the commission.23
(5) All funds in the impaired physician account shall be paid to 24
the contract entity within ((sixty)) 60 days of deposit.25
Sec. 7. RCW 18.71A.030 and 2024 c 62 s 5 are each amended to 26
read as follows: 27
(1) A physician ((assistant)) associate may practice medicine in 28
this state to the extent permitted by the collaboration agreement. A 29
physician ((assistant)) associate shall be subject to discipline 30
under chapter 18.130 RCW. 31
(2)(a) A physician ((assistant)) associate who has completed 32
fewer than 4,000 hours of postgraduate clinical practice must work 33
under the supervision of a participating physician, as described in 34
the collaboration agreement and determined at the practice site. A 35
physician ((assistant)) associate with 4,000 or more hours of 36
postgraduate clinical practice may work in collaboration with a 37
participating physician, if the physician ((assistant)) associate has 38
p. 6 HB 2127
completed 2,000 or more supervised hours in the physician 1
((assistant's)) associate's chosen specialty. 2
(b) If a physician ((assistant)) associate chooses to change 3
specialties after the completion of 4,000 hours of postgraduate 4
clinical practice, the first 2,000 hours of postgraduate clinical 5
practice in the new specialty must be completed under the supervision 6
of a participating physician, as described in the collaboration 7
agreement and determined at the practice site. 8
(c) Supervision shall not be construed to necessarily require the 9
personal presence of the participating physician or physicians at the 10
place where services are rendered. 11
(3)(a) Physician ((assistants)) associates may provide services 12
that they are competent to perform based on their education, 13
training, and experience and that are consistent with their 14
collaboration agreement. The participating physician or physicians, 15
or the physician ((assistant's)) associate's employer, and the 16
physician ((assistant)) associate shall determine which procedures 17
may be performed and the degree of autonomy under which the procedure 18
is performed. 19
(b) Physician ((assistants)) associates may practice in any area 20
of medicine or surgery as long as the practice is not beyond the 21
scope of expertise and clinical practice of the participating 22
physician or physicians or the group of physicians within the 23
department or specialty areas in which the physician ((assistant)) 24
associate practices. 25
(c) A physician ((assistant)) associate who has at least 10 years 26
or 20,000 hours of postgraduate clinical experience in a specialty 27
may continue to provide those specialty services if the physician 28
((assistant)) associate is employed in a practice setting where those 29
services are outside the specialty of the physician ((assistant's)) 30
associate's participating physician or physicians, as outlined in the 31
collaboration agreement, if the practice is located in a rural area 32
as identified by the department under RCW 70.180.011 or in an 33
underserved area as designated by the health resources and services 34
administration as a medically underserved area or having a medically 35
underserved population. The physician ((assistant)) associate must 36
complete continuing education related to that specialty while 37
performing services outside the specialty of the physician 38
((assistant's)) associate's participating physician or physicians.39
p. 7 HB 2127
(4) A physician ((assistant)) associate working with an 1
anesthesiologist who is acting as a participating physician as 2
defined in RCW 18.71A.010 to deliver general anesthesia or 3
intrathecal anesthesia pursuant to a collaboration agreement shall 4
show evidence of adequate education and training in the delivery of 5
the type of anesthesia being delivered on the physician 6
((assistant's)) associate's collaboration agreement as stipulated by 7
the commission. 8
Sec. 8. RCW 18.71A.045 and 1994 sp.s. c 9 s 322 are each amended 9
to read as follows: 10
Foreign medical school graduates shall not be eligible for 11
licensing as physician ((assistants)) associates after July 1, 1989.12
Sec. 9. RCW 18.71A.050 and 2024 c 62 s 6 are each amended to 13
read as follows: 14
No physician or employer who enters into a collaboration 15
agreement with a licensed physician ((assistant)) associate in 16
accordance with and within the terms of any permission granted by the 17
commission is considered as aiding and abetting an unlicensed person 18
to practice medicine. The physician ((assistant)) associate shall 19
retain responsibility for any act which constitutes the practice of 20
medicine as defined in RCW 18.71.011 or the practice of osteopathic 21
medicine and surgery as defined in RCW 18.57.001 when performed by 22
the physician ((assistant)) associate. 23
Sec. 10. RCW 18.71A.060 and 1994 sp.s. c 9 s 324 are each 24
amended to read as follows: 25
No health care services may be performed under this chapter in 26
any of the following areas: 27
(1) The measurement of the powers or range of human vision, or 28
the determination of the accommodation and refractive state of the 29
human eye or the scope of its functions in general, or the fitting or 30
adaptation of lenses or frames for the aid thereof.31
(2) The prescribing or directing the use of, or using, any 32
optical device in connection with ocular exercises, visual training, 33
vision training, or orthoptics. 34
(3) The prescribing of contact lenses for, or the fitting or 35
adaptation of contact lenses to, the human eye. 36
p. 8 HB 2127
(4) Nothing in this section shall preclude the performance of 1
routine visual screening. 2
(5) The practice of dentistry or dental hygiene as defined in 3
chapters 18.32 and 18.29 RCW respectively. The exemptions set forth 4
in RCW 18.32.030 (1) and (8), shall not apply to a physician 5
((assistant)) associate. 6
(6) The practice of chiropractic as defined in chapter 18.25 RCW 7
including the adjustment or manipulation of the articulations of the 8
spine. 9
(7) The practice of podiatric medicine and surgery as defined in 10
chapter 18.22 RCW. 11
Sec. 11. RCW 18.71A.085 and 1994 sp.s. c 9 s 325 are each 12
amended to read as follows: 13
Any physician ((assistant)) associate acupuncturist currently 14
licensed by the commission may continue to perform acupuncture under 15
the physician ((assistant)) associate license as long as he or she 16
maintains licensure as a physician ((assistant)) associate.17
Sec. 12. RCW 18.71A.090 and 2024 c 62 s 7 are each amended to 18
read as follows: 19
(1) A physician ((assistant)) associate may sign and attest to 20
any certificates, cards, forms, or other required documentation that 21
the physician ((assistant's)) associate's participating physician or 22
physician group may sign, provided that it is within the physician 23
((assistant's)) associate's scope of practice and is consistent with 24
the terms of the physician ((assistant's)) associate's collaboration 25
agreement as required by this chapter. 26
(2) Notwithstanding any federal law, rule, or medical staff bylaw 27
provision to the contrary, a physician is not required to countersign 28
orders written in a patient's clinical record or an official form by 29
a physician ((assistant)) associate with whom the physician has a 30
collaboration agreement. 31
Sec. 13. RCW 18.71A.100 and 2010 c 209 s 6 are each amended to 32
read as follows: 33
(1) By June 30, 2011, the commission shall adopt new rules on 34
chronic, noncancer pain management that contain the following 35
elements: 36
(a)(i) Dosing criteria, including: 37
p. 9 HB 2127
(A) A dosage amount that must not be exceeded unless a physician 1
((assistant)) associate first consults with a practitioner 2
specializing in pain management; and 3
(B) Exigent or special circumstances under which the dosage 4
amount may be exceeded without consultation with a practitioner 5
specializing in pain management. 6
(ii) The rules regarding consultation with a practitioner 7
specializing in pain management must, to the extent practicable, take 8
into account: 9
(A) Circumstances under which repeated consultations would not be 10
necessary or appropriate for a patient undergoing a stable, ongoing 11
course of treatment for pain management; 12
(B) Minimum training and experience that is sufficient to exempt 13
a physician ((assistant)) associate from the specialty consultation 14
requirement; 15
(C) Methods for enhancing the availability of consultations;16
(D) Allowing the efficient use of resources; and17
(E) Minimizing the burden on practitioners and patients;18
(b) Guidance on when to seek specialty consultation and ways in 19
which electronic specialty consultations may be sought;20
(c) Guidance on tracking clinical progress by using assessment 21
tools focusing on pain interference, physical function, and overall 22
risk for poor outcome; and 23
(d) Guidance on tracking the use of opioids, particularly in the 24
emergency department. 25
(2) The commission shall consult with the agency medical 26
directors' group, the department of health, the University of 27
Washington, and the largest professional association of physician 28
((assistants)) associates in the state. 29
(3) The rules adopted under this section do not apply:30
(a) To the provision of palliative, hospice, or other end -of-life 31
care; or 32
(b) To the management of acute pain caused by an injury or a 33
surgical procedure. 34
Sec. 14. RCW 18.71A.110 and 2016 c 70 s 6 are each amended to 35
read as follows: 36
A physician ((assistant)) associate who provides a parent with a 37
positive prenatal or postnatal diagnosis of Down syndrome shall 38
provide the parent with the information prepared by the department 39
p. 10 HB 2127
under RCW 43.70.738 at the time the physician ((assistant)) associate 1
provides the parent with the Down syndrome diagnosis.2
Sec. 15. RCW 18.71A.120 and 2024 c 62 s 8 are each amended to 3
read as follows: 4
(1)(a) Prior to commencing practice, a physician ((assistant)) 5
associate licensed in Washington state must enter into a 6
collaboration agreement that identifies at least one participating 7
physician and that is signed by one or more participating physicians 8
or the physician ((assistant's)) associate's employer.9
(b) A collaboration agreement must be signed by a physician if 10
the physician ((assistant's)) associate's employer is not a 11
physician. 12
(c) If a participating physician is not a signatory to the 13
collaboration agreement, the participating physician must be provided 14
notice of the agreement and an opportunity to decline participation. 15
Entering into a collaboration agreement is voluntary for the 16
physician ((assistant)) associate and the participating physician or 17
employer. A physician may not be compelled to participate in a 18
collaboration agreement as a condition of employment.19
(d) Prior to entering into the collaboration agreement, the 20
participating physician or physicians, employer, or their designee 21
must verify the physician ((assistant's)) associate's credentials.22
(e) The protections of RCW 43.70.075 apply to any participating 23
physician or employer who reports to the commission acts of 24
retaliation or reprisal for declining to sign a collaboration 25
agreement. 26
(f) The collaboration agreement must be available either 27
electronically or on paper at the physician ((assistant's)) 28
associate's primary location of practice and made available to the 29
commission upon request. 30
(g) The commission shall develop a model collaboration agreement.31
(h) The commission shall establish administrative procedures, 32
administrative requirements, and fees as provided in RCW 43.70.250 33
and 43.70.280. 34
(2) A collaboration agreement must include all of the following:35
(a) The duties and responsibilities of the physician 36
((assistant)) associate and the participating physician or 37
physicians. The collaboration agreement must describe the supervision 38
or collaboration requirements for specified procedures or areas of 39
p. 11 HB 2127
practice, depending on the number of postgraduate clinical practice 1
hours completed. The collaboration agreement may only include acts, 2
tasks, or functions that the physician ((assistant)) associate is 3
qualified to perform by education, training, or experience. The acts, 4
tasks, or functions included in the collaboration agreement must also 5
be within the scope of expertise and clinical practice of either the 6
participating physician or physicians or the group of physicians 7
within the department or specialty areas in which the physician 8
((assistant)) associate is practicing, unless otherwise authorized by 9
law, rule, or the commission; 10
(b) A process between the physician ((assistant)) associate and 11
participating physician or physicians for communication, 12
availability, and decision making when providing medical treatment to 13
a patient or in the event of an acute health care crisis not 14
previously covered by the collaboration agreement, such as a flu 15
pandemic or other unforeseen emergency. Communications may occur in 16
person, electronically, by telephone, or by an alternate method;17
(c) If there is only one participating physician identified in 18
the collaboration agreement, a protocol for designating another 19
participating physician for consultation in situations in which the 20
physician is not available; 21
(d) The signature of the physician ((assistant)) associate and 22
the signature or signatures of the participating physician or 23
physicians, or employer; 24
(e) If the physician ((assistant)) associate is working under the 25
supervision of a participating physician, in accordance with RCW 26
18.71A.030, a plan for how the physician ((assistant)) associate will 27
be supervised; 28
(f) An attestation by the physician ((assistant)) associate of 29
the number of postgraduate clinical practice hours completed, 30
including the number of hours completed in a chosen specialty, at the 31
time the physician ((assistant)) associate signs the collaboration 32
agreement; and 33
(g) A termination provision. A physician ((assistant)) associate 34
or physician may terminate the collaboration agreement as it applies 35
to a single participating physician without terminating the agreement 36
with respect to the remaining participating physicians. If the 37
termination results in no participating physician being designated on 38
the agreement, a new participating physician must be designated for 39
the agreement to be valid. 40
p. 12 HB 2127
(i) Except as provided in (g)(ii) of this subsection, the 1
physician ((assistant)) associate or participating physician must 2
provide written notice at least ((thirty)) 30 days prior to the 3
termination. 4
(ii) The physician ((assistant)) associate or participating 5
physician may terminate the collaboration agreement immediately due 6
to good faith concerns regarding unprofessional conduct or failure to 7
practice medicine while exercising reasonable skill and safety.8
(3) The physician ((assistant)) associate is responsible for 9
tracking the number of postgraduate clinical hours completed, 10
including the number of hours completed in a chosen specialty.11
(4) A collaboration agreement may be amended for any reason.12
(5) Whenever a physician ((assistant)) associate is practicing in 13
a manner inconsistent with the collaboration agreement, the 14
commission may take disciplinary action under chapter 18.130 RCW.15
(6) Whenever a physician is subject to disciplinary action under 16
chapter 18.130 RCW related to the practice of a physician 17
((assistant)) associate, the case must be referred to the appropriate 18
disciplining authority. 19
(7) A physician ((assistant)) associate, physician, or employer 20
may participate in more than one collaboration agreement if the 21
physician or employer is reasonably able to fulfill the duties and 22
responsibilities in each agreement. 23
(8) Nothing in this section shall be construed as prohibiting 24
physician ((assistants)) associates from owning their own practice or 25
clinic. 26
Sec. 16. RCW 18.71A.800 and 2017 c 297 s 7 are each amended to 27
read as follows: 28
(1) By January 1, 2019, the commission must adopt rules 29
establishing requirements for prescribing opioid drugs. The rules may 30
contain exemptions based on education, training, amount of opioids 31
prescribed, patient panel, and practice environment.32
(2) In developing the rules, the commission must consider the 33
agency medical directors' group and centers for disease control 34
guidelines, and may consult with the department of health, the 35
University of Washington, and the largest professional association of 36
physician ((assistants)) associates in the state. 37
p. 13 HB 2127
Sec. 17. RCW 18.71A.810 and 2019 c 314 s 9 are each amended to 1
read as follows: 2
By January 1, 2020, the commission must adopt or amend its rules 3
to require physician ((assistants)) associates who prescribe opioids 4
to inform patients of their right to refuse an opioid prescription or 5
order for any reason. If a patient indicates a desire to not receive 6
an opioid, the physician ((assistant)) associate must document the 7
patient's request and avoid prescribing or ordering opioids, unless 8
the request is revoked by the patient. 9
Sec. 18. RCW 18.71A.820 and 2024 c 62 s 10 are each amended to 10
read as follows: 11
A physician ((assistant)) associate practicing under a practice 12
agreement that was entered into before July 1, 2025, may continue to 13
practice under the practice agreement until the physician 14
((assistant)) associate enters into a collaboration agreement, as 15
defined in RCW 18.71A.010. A physician ((assistant)) associate 16
described in this section shall enter into a collaboration agreement 17
not later than the date on which the physician ((assistant's)) 18
associate's license is due for renewal or July 1, 2025, whichever is 19
later. 20
Sec. 19. RCW 4.24.240 and 2019 c 308 s 14 are each amended to 21
read as follows: 22
(1)(a) A person licensed by this state to provide health care or 23
related services including, but not limited to, an acupuncturist or 24
acupuncture and Eastern medicine practitioner, a physician, 25
osteopathic physician, dentist, nurse, optometrist, podiatric 26
physician and surgeon, chiropractor, physical therapist, 27
psychologist, pharmacist, optician, physician ((assistant, 28
osteopathic physician's assistant )) associate, nurse practitioner, 29
including, in the event such person is deceased, his or her estate or 30
personal representative; 31
(b) An employee or agent of a person described in 32
((subparagraph)) (a) of this subsection, acting in the course and 33
scope of his or her employment, including, in the event such employee 34
or agent is deceased, his or her estate or personal representative; 35
or 36
(c) An entity, whether or not incorporated, facility, or 37
institution employing one or more persons described in 38
p. 14 HB 2127
((subparagraph)) (a) of this subsection, including, but not limited 1
to, a hospital, clinic, health maintenance organization, or nursing 2
home; or an officer, director, trustee, employee, or agent thereof 3
acting in the course and scope of his or her employment, including in 4
the event such officer, director, employee, or agent is deceased, his 5
or her estate or personal representative; 6
shall be immune from civil action for damages arising out of the good 7
faith performance of their duties on such committees, where such 8
actions are being brought by or on behalf of the person who is being 9
evaluated. 10
(2) No member, employee, staff person, or investigator of a 11
professional review committee shall be liable in a civil action as a 12
result of acts or omissions made in good faith on behalf of the 13
committee; nor shall any person be so liable for filing charges with 14
or supplying information or testimony in good faith to any 15
professional review committee; nor shall a member, employee, staff 16
person, or investigator of a professional society, of a professional 17
examining or licensing board, of a professional disciplinary board, 18
of a governing board of any institution, or of any employer of 19
professionals be so liable for good faith acts or omissions made in 20
full or partial reliance on recommendations or decisions of a 21
professional review committee or examining board. 22
Sec. 20. RCW 7.68.030 and 2025 c 58 s 5058 are each amended to 23
read as follows: 24
(1) It shall be the duty of the director to establish and 25
administer a program of benefits to innocent victims of criminal acts 26
within the terms and limitations of this chapter. The director may 27
apply for and, subject to appropriation, expend federal funds under 28
((Public Law [P.L.] )) P.L. 98-473 and any other federal program 29
providing financial assistance to state crime victim compensation 30
programs. The federal funds shall be deposited in the state general 31
fund and may be expended only for purposes authorized by applicable 32
federal law. 33
(2) The director shall: 34
(a) Establish and adopt rules governing the administration of 35
this chapter in accordance with chapter 34.05 RCW;36
(b) Regulate the proof of accident and extent thereof, the proof 37
of death, and the proof of relationship and the extent of dependency;38
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(c) Supervise the medical, surgical, and hospital treatment to 1
the intent that it may be in all cases efficient and up to the 2
recognized standard of modern surgery; 3
(d) Issue proper receipts for moneys received and certificates 4
for benefits accrued or accruing; 5
(e) Designate a medical director who is licensed under chapter 6
18.57 or 18.71 RCW; 7
(f) Supervise the providing of prompt and efficient care and 8
treatment, including care provided by physician ((assistants)) 9
associates governed by the provisions of chapter 18.71A RCW, 10
including chiropractic care, and including care provided by licensed 11
advanced practice registered nurses, to victims at the least cost 12
consistent with promptness and efficiency, without discrimination or 13
favoritism, and with as great uniformity as the various and diverse 14
surrounding circumstances and locations of industries will permit and 15
to that end shall, from time to time, establish and adopt and 16
supervise the administration of printed forms, electronic 17
communications, rules, regulations, and practices for the furnishing 18
of such care and treatment. The medical coverage decisions of the 19
department do not constitute a "rule" as used in RCW 34.05.010(16), 20
nor are such decisions subject to the rule -making provisions of 21
chapter 34.05 RCW except that criteria for establishing medical 22
coverage decisions shall be adopted by rule. The department may 23
recommend to a victim particular health care services and providers 24
where specialized treatment is indicated or where cost-effective 25
payment levels or rates are obtained by the department, and the 26
department may enter into contracts for goods and services including, 27
but not limited to, durable medical equipment so long as statewide 28
access to quality service is maintained for injured victims;29
(g) In consultation with interested persons, establish and, in 30
his or her discretion, periodically change as may be necessary, and 31
make available a fee schedule of the maximum charges to be made by 32
any physician, surgeon, chiropractor, hospital, druggist, licensed 33
advanced practice registered nurse, physician ((assistants)) 34
associates as defined in chapter 18.71A RCW, acting under the 35
supervision of or in coordination with a participating physician, as 36
defined in RCW 18.71A.010, or other agency or person rendering 37
services to victims. The department shall coordinate with other state 38
purchasers of health care services to establish as much consistency 39
and uniformity in billing and coding practices as possible, taking 40
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into account the unique requirements and differences between 1
programs. No service covered under this title, including services 2
provided to victims, whether aliens or other victims, who are not 3
residing in the United States at the time of receiving the services, 4
shall be charged or paid at a rate or rates exceeding those specified 5
in such fee schedule, and no contract providing for greater fees 6
shall be valid as to the excess. The establishment of such a 7
schedule, exclusive of conversion factors, does not constitute 8
"agency action" as used in RCW 34.05.010(3), nor does such a fee 9
schedule constitute a "rule" as used in RCW 34.05.010(16). Payments 10
for providers' services under the fee schedule established pursuant 11
to this subsection (2) may not be less than payments provided for 12
comparable services under the workers' compensation program under 13
Title 51 RCW, provided: 14
(i) If the department, using caseload estimates, projects a 15
deficit in funding for the program by July 15th for the following 16
fiscal year, the director shall notify the governor and the 17
appropriate committees of the legislature and request funding 18
sufficient to continue payments to not less than payments provided 19
for comparable services under the workers' compensation program. If 20
sufficient funding is not provided to continue payments to not less 21
than payments provided for comparable services under the workers' 22
compensation program, the director shall reduce the payments under 23
the fee schedule for the following fiscal year based on caseload 24
estimates and available funding, except payments may not be reduced 25
to less than seventy percent of payments for comparable services 26
under the workers' compensation program; 27
(ii) If an unforeseeable catastrophic event results in 28
insufficient funding to continue payments to not less than payments 29
provided for comparable services under the workers' compensation 30
program, the director shall reduce the payments under the fee 31
schedule to not less than seventy percent of payments provided for 32
comparable services under the workers' compensation program, provided 33
that the reduction may not be more than necessary to fund benefits 34
under the program; and 35
(iii) Once sufficient funding is provided or otherwise available, 36
the director shall increase the payments under the fee schedule to 37
not less than payments provided for comparable services under the 38
workers' compensation program; 39
p. 17 HB 2127
(h) Make a record of the commencement of every disability and the 1
termination thereof and, when bills are rendered for the care and 2
treatment of injured victims, shall approve and pay those which 3
conform to the adopted rules, regulations, established fee schedules, 4
and practices of the director and may reject any bill or item thereof 5
incurred in violation of the principles laid down in this section or 6
the rules, regulations, or the established fee schedules and rules 7
and regulations adopted under it. 8
(3) The director and his or her authorized assistants:9
(a) Have power to issue subpoenas to enforce the attendance and 10
testimony of witnesses and the production and examination of books, 11
papers, photographs, tapes, and records before the department in 12
connection with any claim made to the department or any billing 13
submitted to the department. The superior court has the power to 14
enforce any such subpoena by proper proceedings; 15
(b)(i) May apply for and obtain a superior court order approving 16
and authorizing a subpoena in advance of its issuance. The 17
application may be made in the county where the subpoenaed person 18
resides or is found, or the county where the subpoenaed records or 19
documents are located, or in Thurston county. The application must 20
(A) state that an order is sought pursuant to this subsection; (B) 21
adequately specify the records, documents, or testimony; and (C) 22
declare under oath that an investigation is being conducted for a 23
lawfully authorized purpose related to an investigation within the 24
department's authority and that the subpoenaed documents or testimony 25
are reasonably related to an investigation within the department's 26
authority. 27
(ii) Where the application under this subsection (3)(b) is made 28
to the satisfaction of the court, the court must issue an order 29
approving the subpoena. An order under this subsection constitutes 30
authority of law for the agency to subpoena the records or testimony.31
(iii) The director and his or her authorized assistants may seek 32
approval and a court may issue an order under this subsection without 33
prior notice to any person, including the person to whom the subpoena 34
is directed and the person who is the subject of an investigation.35
(4) In all hearings, actions, or proceedings before the 36
department, any physician or licensed advanced practice registered 37
nurse having theretofore examined or treated the claimant may be 38
required to testify fully regarding such examination or treatment, 39
and shall not be exempt from so testifying by reason of the relation 40
p. 18 HB 2127
of the physician or licensed advanced practice registered nurse to 1
the patient. 2
Sec. 21. RCW 7.70.020 and 2019 c 308 s 16 are each amended to 3
read as follows: 4
As used in this chapter "health care provider" means either:5
(1) A person licensed by this state to provide health care or 6
related services including, but not limited to, an acupuncturist or 7
acupuncture and Eastern medicine practitioner, a physician, 8
osteopathic physician, dentist, nurse, optometrist, podiatric 9
physician and surgeon, chiropractor, physical therapist, 10
psychologist, pharmacist, optician, physician ((assistant)) 11
associate, midwife, ((osteopathic physician's assistant, )) nurse 12
practitioner, or physician's trained mobile intensive care paramedic, 13
including, in the event such person is deceased, his or her estate or 14
personal representative; 15
(2) An employee or agent of a person described in ((part (1) 16
above)) subsection (1) of this section , acting in the course and 17
scope of his (([or her])) or her employment, including, in the event 18
such employee or agent is deceased, his or her estate or personal 19
representative; or 20
(3) An entity, whether or not incorporated, facility, or 21
institution employing one or more persons described in ((part (1) 22
above,)) subsection (1) of this section including, but not limited 23
to, a hospital, clinic, health maintenance organization, or nursing 24
home; or an officer, director, employee, or agent thereof acting in 25
the course and scope of his or her employment, including in the event 26
such officer, director, employee, or agent is deceased, his or her 27
estate or personal representative. 28
Sec. 22. RCW 9.02.110 and 2025 c 58 s 5061 are each amended to 29
read as follows: 30
The state may not deny or interfere with a pregnant individual's 31
right to choose to have an abortion prior to viability of the fetus, 32
or to protect the pregnant individual's life or health.33
A physician, physician ((assistant)) associate, advanced practice 34
registered nurse, or other health care provider acting within the 35
provider's scope of practice may terminate and a health care provider 36
may assist a physician, physician ((assistant)) associate, advanced 37
practice registered nurse, or other health care provider acting 38
p. 19 HB 2127
within the provider's scope of practice in terminating a pregnancy as 1
permitted by this section. 2
Sec. 23. RCW 9.02.130 and 2025 c 58 s 5062 are each amended to 3
read as follows: 4
The good faith judgment of a physician, physician ((assistant)) 5
associate, advanced practice registered nurse, or other health care 6
provider acting within the provider's scope of practice as to 7
viability of the fetus or as to the risk to life or health of a 8
pregnant individual and the good faith judgment of a health care 9
provider as to the duration of pregnancy shall be a defense in any 10
proceeding in which a violation of this chapter is an issue.11
Sec. 24. RCW 9.02.170 and 2025 c 58 s 5063 are each amended to 12
read as follows: 13
For purposes of this chapter: 14
(1) "Abortion" means any medical treatment intended to induce the 15
termination of a pregnancy except for the purpose of producing a live 16
birth. 17
(2) "Advanced practice registered nurse" means an advanced 18
practice registered nurse licensed under chapter 18.79 RCW.19
(3) "Health care provider" means a person regulated under Title 20
18 RCW to practice health or health-related services or otherwise 21
practicing health care services in this state consistent with state 22
law. 23
(4) "Physician" means a physician licensed to practice under 24
chapter 18.57 or 18.71 RCW in the state of Washington.25
(5) "Physician ((assistant)) associate" means a physician 26
((assistant)) associate licensed to practice under chapter 18.71A RCW 27
in the state of Washington. 28
(6) "Pregnancy" means the reproductive process beginning with the 29
implantation of an embryo. 30
(7) "Private medical facility" means any medical facility that is 31
not owned or operated by the state. 32
(8) "State" means the state of Washington and counties, cities, 33
towns, municipal corporations, and quasi-municipal corporations in 34
the state of Washington. 35
(9) "Viability" means the point in the pregnancy when, in the 36
judgment of the physician, physician ((assistant)) associate, 37
advanced practice registered nurse, or other health care provider 38
p. 20 HB 2127
acting within the provider's scope of practice on the particular 1
facts of the case before such physician, physician ((assistant)) 2
associate, advanced practice registered nurse, or other health care 3
provider acting within the provider's scope of practice, there is a 4
reasonable likelihood of the fetus's sustained survival outside the 5
uterus without the application of extraordinary medical measures.6
Sec. 25. RCW 9.41.010 and 2025 c 58 s 5064 are each amended to 7
read as follows: 8
Unless the context clearly requires otherwise, the definitions in 9
this section apply throughout this chapter. 10
(1) "Antique firearm" means a firearm or replica of a firearm not 11
designed or redesigned for using rim fire or conventional center fire 12
ignition with fixed ammunition and manufactured in or before 1898, 13
including any matchlock, flintlock, percussion cap, or similar type 14
of ignition system and also any firearm using fixed ammunition 15
manufactured in or before 1898, for which ammunition is no longer 16
manufactured in the United States and is not readily available in the 17
ordinary channels of commercial trade. 18
(2)(a) "Assault weapon" means: 19
(i) Any of the following specific firearms regardless of which 20
company produced and manufactured the firearm: 21
22 AK-47 in all forms
23 AK-74 in all forms
24 Algimec AGM-1 type semiautomatic
25 American Arms Spectre da semiautomatic carbine
26 AR15, M16, or M4 in all forms
27 AR 180 type semiautomatic
28 Argentine L.S.R. semiautomatic
29 Australian Automatic
30 Auto-Ordnance Thompson M1 and 1927 semiautomatics
31 Barrett .50 cal light semiautomatic
32 Barrett .50 cal M87
33 Barrett .50 cal M107A1
34 Barrett REC7
35 Beretta AR70/S70 type semiautomatic
p. 21 HB 2127
1 Bushmaster Carbon 15
2 Bushmaster ACR
3 Bushmaster XM-15
4 Bushmaster MOE
5 Calico models M100 and M900
6 CETME Sporter
7 CIS SR 88 type semiautomatic
8 Colt CAR 15
9 Daewoo K-1
10 Daewoo K-2
11 Dragunov semiautomatic
12 Fabrique Nationale FAL in all forms
13 Fabrique Nationale F2000
14 Fabrique Nationale L1A1 Sporter
15 Fabrique Nationale M249S
16 Fabrique Nationale PS90
17 Fabrique Nationale SCAR
18 FAMAS .223 semiautomatic
19 Galil
20 Heckler & Koch G3 in all forms
21 Heckler & Koch HK-41/91
22 Heckler & Koch HK-43/93
23 Heckler & Koch HK94A2/3
24 Heckler & Koch MP-5 in all forms
25 Heckler & Koch PSG-1
26 Heckler & Koch SL8
27 Heckler & Koch UMP
28 Manchester Arms Commando MK-45
29 Manchester Arms MK-9
30 SAR-4800
31 SIG AMT SG510 in all forms
32 SIG SG550 in all forms
p. 22 HB 2127
1 SKS
2 Spectre M4
3 Springfield Armory BM-59
4 Springfield Armory G3
5 Springfield Armory SAR-8
6 Springfield Armory SAR-48
7 Springfield Armory SAR-3
8 Springfield Armory M-21 sniper
9 Springfield Armory M1A
10 Smith & Wesson M&P 15
11 Sterling Mk 1
12 Sterling Mk 6/7
13 Steyr AUG
14 TNW M230
15 FAMAS F11
16 Uzi 9mm carbine/rifle
(ii) A semiautomatic rifle that has an overall length of less 17
than 30 inches; 18
(iii) A conversion kit, part, or combination of parts, from which 19
an assault weapon can be assembled or from which a firearm can be 20
converted into an assault weapon if those parts are in the possession 21
or under the control of the same person; or 22
(iv) A semiautomatic, center fire rifle that has the capacity to 23
accept a detachable magazine and has one or more of the following:24
(A) A grip that is independent or detached from the stock that 25
protrudes conspicuously beneath the action of the weapon. The 26
addition of a fin attaching the grip to the stock does not exempt the 27
grip if it otherwise resembles the grip found on a pistol;28
(B) Thumbhole stock; 29
(C) Folding or telescoping stock; 30
(D) Forward pistol, vertical, angled, or other grip designed for 31
use by the nonfiring hand to improve control; 32
(E) Flash suppressor, flash guard, flash eliminator, flash hider, 33
sound suppressor, silencer, or any item designed to reduce the visual 34
or audio signature of the firearm; 35
p. 23 HB 2127
(F) Muzzle brake, recoil compensator, or any item designed to be 1
affixed to the barrel to reduce recoil or muzzle rise;2
(G) Threaded barrel designed to attach a flash suppressor, sound 3
suppressor, muzzle break, or similar item; 4
(H) Grenade launcher or flare launcher; or 5
(I) A shroud that encircles either all or part of the barrel 6
designed to shield the bearer's hand from heat, except a solid 7
forearm of a stock that covers only the bottom of the barrel;8
(v) A semiautomatic, center fire rifle that has a fixed magazine 9
with the capacity to accept more than 10 rounds; 10
(vi) A semiautomatic pistol that has the capacity to accept a 11
detachable magazine and has one or more of the following:12
(A) A threaded barrel, capable of accepting a flash suppressor, 13
forward handgrip, or silencer; 14
(B) A second hand grip; 15
(C) A shroud that encircles either all or part of the barrel 16
designed to shield the bearer's hand from heat, except a solid 17
forearm of a stock that covers only the bottom of the barrel; or18
(D) The capacity to accept a detachable magazine at some location 19
outside of the pistol grip; 20
(vii) A semiautomatic shotgun that has any of the following:21
(A) A folding or telescoping stock; 22
(B) A grip that is independent or detached from the stock that 23
protrudes conspicuously beneath the action of the weapon. The 24
addition of a fin attaching the grip to the stock does not exempt the 25
grip if it otherwise resembles the grip found on a pistol;26
(C) A thumbhole stock; 27
(D) A forward pistol, vertical, angled, or other grip designed 28
for use by the nonfiring hand to improve control; 29
(E) A fixed magazine in excess of seven rounds; or30
(F) A revolving cylinder shotgun. 31
(b) For the purposes of this subsection, "fixed magazine" means 32
an ammunition feeding device contained in, or permanently attached 33
to, a firearm in such a manner that the device cannot be removed 34
without disassembly of the firearm action. 35
(c) "Assault weapon" does not include antique firearms, any 36
firearm that has been made permanently inoperable, or any firearm 37
that is manually operated by bolt, pump, lever, or slide action.38
(3) "Assemble" means to fit together component parts.39
p. 24 HB 2127
(4) "Barrel length" means the distance from the bolt face of a 1
closed action down the length of the axis of the bore to the crown of 2
the muzzle, or in the case of a barrel with attachments to the end of 3
any legal device permanently attached to the end of the muzzle.4
(5) "Bump-fire stock" means a butt stock designed to be attached 5
to a semiautomatic firearm with the effect of increasing the rate of 6
fire achievable with the semiautomatic firearm to that of a fully 7
automatic firearm by using the energy from the recoil of the firearm 8
to generate reciprocating action that facilitates repeated activation 9
of the trigger. 10
(6) "Conviction" or "convicted" means, whether in an adult court 11
or adjudicated in a juvenile court, that a plea of guilty has been 12
accepted or a verdict of guilty has been filed, or a finding of guilt 13
has been entered, notwithstanding the pendency of any future 14
proceedings including, but not limited to, sentencing or disposition, 15
posttrial or post-fact-finding motions, and appeals. "Conviction" 16
includes a dismissal entered after a period of probation, suspension, 17
or deferral of sentence, and also includes equivalent dispositions by 18
courts in jurisdictions other than Washington state.19
(7) "Crime of violence" means: 20
(a) Any of the following felonies, as now existing or hereafter 21
amended: Any felony defined under any law as a class A felony or an 22
attempt to commit a class A felony, criminal solicitation of or 23
criminal conspiracy to commit a class A felony, manslaughter in the 24
first degree, manslaughter in the second degree, indecent liberties 25
if committed by forcible compulsion, kidnapping in the second degree, 26
arson in the second degree, assault in the second degree, assault of 27
a child in the second degree, extortion in the first degree, burglary 28
in the second degree, residential burglary, and robbery in the second 29
degree; 30
(b) Any conviction for a felony offense in effect at any time 31
prior to June 6, 1996, which is comparable to a felony classified as 32
a crime of violence in (a) of this subsection; and33
(c) Any federal or out-of-state conviction for an offense 34
comparable to a felony classified as a crime of violence under (a) or 35
(b) of this subsection. 36
(8) "Curio or relic" has the same meaning as provided in 27 37
C.F.R. Sec. 478.11. 38
(9) "Dealer" means a person engaged in the business of selling 39
firearms at wholesale or retail who has, or is required to have, a 40
p. 25 HB 2127
federal firearms license under 18 U.S.C. Sec. 923 (a). A person who 1
does not have, and is not required to have, a federal firearms 2
license under 18 U.S.C. Sec. 923 (a), is not a dealer if that person 3
makes only occasional sales, exchanges, or purchases of firearms for 4
the enhancement of a personal collection or for a hobby, or sells all 5
or part of his or her personal collection of firearms.6
(10) "Detachable magazine" means an ammunition feeding device 7
that can be loaded or unloaded while detached from a firearm and 8
readily inserted into a firearm. 9
(11) "Distribute" means to give out, provide, make available, or 10
deliver a firearm or large capacity magazine to any person in this 11
state, with or without consideration, whether the distributor is in-12
state or out-of-state. "Distribute" includes, but is not limited to, 13
filling orders placed in this state, online or otherwise. 14
"Distribute" also includes causing a firearm or large capacity 15
magazine to be delivered in this state. 16
(12) "Domestic violence" has the same meaning as provided in RCW 17
10.99.020. 18
(13) "Family or household member" has the same meaning as in RCW 19
7.105.010. 20
(14) "Federal firearms dealer" means a licensed dealer as defined 21
in 18 U.S.C. Sec. 921(a)(11). 22
(15) "Federal firearms importer" means a licensed importer as 23
defined in 18 U.S.C. Sec. 921(a)(9). 24
(16) "Federal firearms manufacturer" means a licensed 25
manufacturer as defined in 18 U.S.C. Sec. 921(a)(10).26
(17) "Felony" means any felony offense under the laws of this 27
state or any federal or out-of-state offense comparable to a felony 28
offense under the laws of this state. 29
(18) "Felony firearm offender" means a person who has previously 30
been convicted or found not guilty by reason of insanity in this 31
state of any felony firearm offense. A person is not a felony firearm 32
offender under this chapter if any and all qualifying offenses have 33
been the subject of an expungement, pardon, annulment, certificate, 34
or rehabilitation, or other equivalent procedure based on a finding 35
of the rehabilitation of the person convicted or a pardon, annulment, 36
or other equivalent procedure based on a finding of innocence.37
(19) "Felony firearm offense" means: 38
(a) Any felony offense that is a violation of this chapter;39
(b) A violation of RCW 9A.36.045; 40
p. 26 HB 2127
(c) A violation of RCW 9A.56.300; 1
(d) A violation of RCW 9A.56.310; 2
(e) Any felony offense if the offender was armed with a firearm 3
in the commission of the offense. 4
(20) "Firearm" means a weapon or device from which a projectile 5
or projectiles may be fired by an explosive such as gunpowder. For 6
the purposes of RCW 9.41.040, "firearm" also includes frames and 7
receivers. "Firearm" does not include a flare gun or other 8
pyrotechnic visual distress signaling device, or a powder-actuated 9
tool or other device designed solely to be used for construction 10
purposes. 11
(21)(a) "Frame or receiver" means a part of a firearm that, when 12
the complete firearm is assembled, is visible from the exterior and 13
provides housing or a structure designed to hold or integrate one or 14
more fire control components, even if pins or other attachments are 15
required to connect the fire control components. Any such part 16
identified with a serial number shall be presumed, absent an official 17
determination by the bureau of alcohol, tobacco, firearms, and 18
explosives or other reliable evidence to the contrary, to be a frame 19
or receiver. 20
(b) For purposes of this subsection, "fire control component" 21
means a component necessary for the firearm to initiate, complete, or 22
continue the firing sequence, including any of the following: Hammer, 23
bolt, bolt carrier, breechblock, cylinder, trigger mechanism, firing 24
pin, striker, or slide rails. 25
(22) "Gun" has the same meaning as firearm. 26
(23) "Import" means to move, transport, or receive an item from a 27
place outside the territorial limits of the state of Washington to a 28
place inside the territorial limits of the state of Washington. 29
"Import" does not mean situations where an individual possesses a 30
large capacity magazine or assault weapon when departing from, and 31
returning to, Washington state, so long as the individual is 32
returning to Washington in possession of the same large capacity 33
magazine or assault weapon the individual transported out of state.34
(24) "Intimate partner" has the same meaning as provided in RCW 35
7.105.010. 36
(25) "Large capacity magazine" means an ammunition feeding device 37
with the capacity to accept more than 10 rounds of ammunition, or any 38
conversion kit, part, or combination of parts, from which such a 39
device can be assembled if those parts are in possession of or under 40
p. 27 HB 2127
the control of the same person, but shall not be construed to include 1
any of the following: 2
(a) An ammunition feeding device that has been permanently 3
altered so that it cannot accommodate more than 10 rounds of 4
ammunition; 5
(b) A 22 caliber tube ammunition feeding device; or6
(c) A tubular magazine that is contained in a lever-action 7
firearm. 8
(26) "Law enforcement officer" includes a general authority 9
Washington peace officer as defined in RCW 10.93.020, or a specially 10
commissioned Washington peace officer as defined in RCW 10.93.020. 11
"Law enforcement officer" also includes a limited authority 12
Washington peace officer as defined in RCW 10.93.020 if such officer 13
is duly authorized by his or her employer to carry a concealed 14
pistol. 15
(27) "Lawful permanent resident" has the same meaning afforded a 16
person "lawfully admitted for permanent residence" in 8 U.S.C. Sec. 17
1101(a)(20). 18
(28) "Licensed collector" means a person who is federally 19
licensed under 18 U.S.C. Sec. 923(b). 20
(29) "Licensed dealer" means a person who is federally licensed 21
under 18 U.S.C. Sec. 923(a). 22
(30) "Loaded" means: 23
(a) There is a cartridge in the chamber of the firearm;24
(b) Cartridges are in a clip that is locked in place in the 25
firearm; 26
(c) There is a cartridge in the cylinder of the firearm, if the 27
firearm is a revolver; 28
(d) There is a cartridge in the tube or magazine that is inserted 29
in the action; or 30
(e) There is a ball in the barrel and the firearm is capped or 31
primed if the firearm is a muzzle loader. 32
(31) "Machine gun" means any firearm known as a machine gun, 33
mechanical rifle, submachine gun, or any other mechanism or 34
instrument not requiring that the trigger be pressed for each shot 35
and having a reservoir clip, disc, drum, belt, or other separable 36
mechanical device for storing, carrying, or supplying ammunition 37
which can be loaded into the firearm, mechanism, or instrument, and 38
fired therefrom at the rate of five or more shots per second.39
p. 28 HB 2127
(32) "Manufacture" means, with respect to a firearm or large 1
capacity magazine, the fabrication, making, formation, production, or 2
construction of a firearm or large capacity magazine, by manual labor 3
or by machinery. 4
(33) "Mental health professional" means a psychiatrist, 5
psychologist, or physician ((assistant)) associate working with a 6
psychiatrist who is acting as a participating physician as defined in 7
RCW 18.71A.010, psychiatric advanced practice registered nurse, 8
psychiatric nurse, social worker, mental health counselor, marriage 9
and family therapist, or such other mental health professionals as 10
may be defined in statute or by rules adopted by the department of 11
health pursuant to the provisions of chapter 71.05 RCW.12
(34) "Nonimmigrant alien" means a person defined as such in 8 13
U.S.C. Sec. 1101(a)(15). 14
(35) "Person" means any individual, corporation, company, 15
association, firm, partnership, club, organization, society, joint 16
stock company, or other legal entity. 17
(36) "Pistol" means any firearm with a barrel less than 16 inches 18
in length, or is designed to be held and fired by the use of a single 19
hand. 20
(37) "Rifle" means a weapon designed or redesigned, made or 21
remade, and intended to be fired from the shoulder and designed or 22
redesigned, made or remade, and intended to use the energy of the 23
explosive in a fixed metallic cartridge to fire only a single 24
projectile through a rifled bore for each single pull of the trigger.25
(38) "Sale" and "sell" mean the actual approval of the delivery 26
of a firearm in consideration of payment or promise of payment.27
(39) "Secure gun storage" means: 28
(a) A locked box, gun safe, or other secure locked storage space 29
that is designed to prevent unauthorized use or discharge of a 30
firearm; and 31
(b) The act of keeping an unloaded firearm stored by such means.32
(40) "Semiautomatic" means any firearm which utilizes a portion 33
of the energy of a firing cartridge to extract the fired cartridge 34
case and chamber the next round, and which requires a separate pull 35
of the trigger to fire each cartridge. 36
(41)(a) "Semiautomatic assault rifle" means any rifle which 37
utilizes a portion of the energy of a firing cartridge to extract the 38
fired cartridge case and chamber the next round, and which requires a 39
separate pull of the trigger to fire each cartridge.40
p. 29 HB 2127
(b) "Semiautomatic assault rifle" does not include antique 1
firearms, any firearm that has been made permanently inoperable, or 2
any firearm that is manually operated by bolt, pump, lever, or slide 3
action. 4
(42) "Serious offense" means any of the following felonies or a 5
felony attempt to commit any of the following felonies, as now 6
existing or hereafter amended: 7
(a) Any crime of violence; 8
(b) Any felony violation of the uniform controlled substances 9
act, chapter 69.50 RCW, that is classified as a class B felony or 10
that has a maximum term of imprisonment of at least 10 years;11
(c) Child molestation in the second degree; 12
(d) Incest when committed against a child under age 14;13
(e) Indecent liberties; 14
(f) Leading organized crime; 15
(g) Promoting prostitution in the first degree;16
(h) Rape in the third degree; 17
(i) Drive-by shooting; 18
(j) Sexual exploitation; 19
(k) Vehicular assault, when caused by the operation or driving of 20
a vehicle by a person while under the influence of intoxicating 21
liquor or any drug or by the operation or driving of a vehicle in a 22
reckless manner; 23
(l) Vehicular homicide, when proximately caused by the driving of 24
any vehicle by any person while under the influence of intoxicating 25
liquor or any drug as defined by RCW 46.61.502, or by the operation 26
of any vehicle in a reckless manner; 27
(m) Any other class B felony offense with a finding of sexual 28
motivation, as "sexual motivation" is defined under RCW 9.94A.030;29
(n) Any other felony with a deadly weapon verdict under RCW 30
9.94A.825; 31
(o) Any felony offense in effect at any time prior to June 6, 32
1996, that is comparable to a serious offense, or any federal or out-33
of-state conviction for an offense that under the laws of this state 34
would be a felony classified as a serious offense;35
(p) Any felony conviction under RCW 9.41.115; or36
(q) Any felony charged under RCW 46.61.502(6) or 46.61.504(6).37
(43) "Sex offense" has the same meaning as provided in RCW 38
9.94A.030. 39
p. 30 HB 2127
(44) "Short-barreled rifle" means a rifle having one or more 1
barrels less than 16 inches in length and any weapon made from a 2
rifle by any means of modification if such modified weapon has an 3
overall length of less than 26 inches. 4
(45) "Short-barreled shotgun" means a shotgun having one or more 5
barrels less than 18 inches in length and any weapon made from a 6
shotgun by any means of modification if such modified weapon has an 7
overall length of less than 26 inches. 8
(46) "Shotgun" means a weapon with one or more barrels, designed 9
or redesigned, made or remade, and intended to be fired from the 10
shoulder and designed or redesigned, made or remade, and intended to 11
use the energy of the explosive in a fixed shotgun shell to fire 12
through a smooth bore either a number of ball shot or a single 13
projectile for each single pull of the trigger. 14
(47) "Substance use disorder professional" means a person 15
certified under chapter 18.205 RCW. 16
(48) "Transfer" means the intended delivery of a firearm to 17
another person without consideration of payment or promise of payment 18
including, but not limited to, gifts and loans. "Transfer" does not 19
include the delivery of a firearm owned or leased by an entity 20
licensed or qualified to do business in the state of Washington to, 21
or return of such a firearm by, any of that entity's employees or 22
agents, defined to include volunteers participating in an honor 23
guard, for lawful purposes in the ordinary course of business.24
(49) "Undetectable firearm" means any firearm that is not as 25
detectable as 3.7 ounces of 17-4 PH stainless steel by walk-through 26
metal detectors or magnetometers commonly used at airports or any 27
firearm where the barrel, the slide or cylinder, or the frame or 28
receiver of the firearm would not generate an image that accurately 29
depicts the shape of the part when examined by the types of X-ray 30
machines commonly used at airports. 31
(50)(a) "Unfinished frame or receiver" means a frame or receiver 32
that is partially complete, disassembled, or inoperable, that: (i) 33
Has reached a stage in manufacture where it may readily be completed, 34
assembled, converted, or restored to a functional state; or (ii) is 35
marketed or sold to the public to become or be used as the frame or 36
receiver of a functional firearm once finished or completed, 37
including without limitation products marketed or sold to the public 38
as an 80 percent frame or receiver or unfinished frame or receiver.39
(b) For purposes of this subsection: 40
p. 31 HB 2127
(i) "Readily" means a process that is fairly or reasonably 1
efficient, quick, and easy, but not necessarily the most efficient, 2
speedy, or easy process. Factors relevant in making this 3
determination, with no single one controlling, include the following: 4
(A) Time, i.e., how long it takes to finish the process; (B) ease, 5
i.e., how difficult it is to do so; (C) expertise, i.e., what 6
knowledge and skills are required; (D) equipment, i.e., what tools 7
are required; (E) availability, i.e., whether additional parts are 8
required, and how easily they can be obtained; (F) expense, i.e., how 9
much it costs; (G) scope, i.e., the extent to which the subject of 10
the process must be changed to finish it; and (H) feasibility, i.e., 11
whether the process would damage or destroy the subject of the 12
process, or cause it to malfunction. 13
(ii) "Partially complete," as it modifies frame or receiver, 14
means a forging, casting, printing, extrusion, machined body, or 15
similar article that has reached a stage in manufacture where it is 16
clearly identifiable as an unfinished component part of a firearm.17
(51) "Unlicensed person" means any person who is not a licensed 18
dealer under this chapter. 19
(52) "Untraceable firearm" means any firearm manufactured after 20
July 1, 2019, that is not an antique firearm and that cannot be 21
traced by law enforcement by means of a serial number affixed to the 22
firearm by a federal firearms manufacturer, federal firearms 23
importer, or federal firearms dealer in compliance with all federal 24
laws and regulations. 25
(53) "Washington state patrol firearms background check program" 26
means the division within the state patrol that conducts background 27
checks for all firearm transfers and the disposition of firearms.28
Sec. 26. RCW 9.97.020 and 2021 c 219 s 3 are each amended to 29
read as follows: 30
(1) Except as provided in this section, no state, county, or 31
municipal department, board, officer, or agency authorized to assess 32
the qualifications of any applicant for a license, certificate of 33
authority, qualification to engage in the practice of a profession or 34
business, or for admission to an examination to qualify for such a 35
license or certificate may disqualify a qualified applicant, solely 36
based on the applicant's criminal history, if the qualified applicant 37
has obtained a certificate of restoration of opportunity and the 38
applicant meets all other statutory and regulatory requirements, 39
p. 32 HB 2127
except as required by federal law or exempted under this subsection. 1
Nothing in this section is interpreted as restoring or creating a 2
means to restore any firearms rights or eligibility to obtain a 3
firearm dealer license pursuant to RCW 9.41.110 or requiring the 4
removal of a protection order. 5
(a)(i) Criminal justice agencies, as defined in RCW 10.97.030, 6
and the Washington state bar association are exempt from this 7
section. 8
(ii) This section does not apply to the licensing, certification, 9
or qualification of the following professionals: Accountants, RCW 10
18.04.295; bail bond agents, RCW 18.185.020; escrow agents, RCW 11
18.44.241; nursing home administrators, RCW 18.52.071; nursing, 12
chapter 18.79 RCW; physicians and physician ((assistants)) 13
associates, chapters 18.71 and 18.71A RCW; private investigators, RCW 14
18.165.030; receivers, RCW 7.60.035; teachers, chapters 28A.405 and 15
28A.410 RCW; notaries public, chapter 42.45 RCW; private 16
investigators, chapter 18.165 RCW; real estate brokers and 17
salespersons, chapters 18.85 and 18.86 RCW; security guards, chapter 18
18.170 RCW; and vulnerable adult care providers, RCW 43.43.842, who 19
are not home care aides, chapter 18.88B RCW, or contracted providers 20
or licensees as defined in RCW 43.20A.715. 21
(iii) To the extent this section conflicts with the requirements 22
for receipt of federal funding under the adoption and safe families 23
act, 42 U.S.C. Sec. 671, this section does not apply.24
(b) Unless otherwise prohibited by law, in cases where an 25
applicant would be disqualified under RCW 43.216.170, and the 26
applicant has obtained a certificate of restoration of opportunity 27
for a disqualifying conviction, the department of children, youth, 28
and families may, after review of relevant factors, including the 29
nature and seriousness of the offense, time that has passed since 30
conviction, changed circumstances since the offense occurred, and the 31
nature of the employment or license sought, at their discretion:32
(i) Allow the applicant to have unsupervised access to children, 33
vulnerable adults, or individuals with mental illness or 34
developmental disabilities if the applicant is otherwise qualified 35
and suitable; or 36
(ii) Disqualify the applicant solely based on the applicant's 37
criminal history. 38
(c) Unless otherwise prohibited by law, in cases in which an 39
applicant would be disqualified under RCW 43.20A.710, 43.43.842, or 40
p. 33 HB 2127
department rule, and the applicant has obtained a certificate of 1
restoration of opportunity for a disqualifying conviction, the 2
department of social and health services may, after review of 3
relevant factors, including the nature and seriousness of the 4
offense, time that has passed since conviction, changed circumstances 5
since the offense occurred, and the nature of the employment or 6
license sought, at its discretion: 7
(i) Allow the applicant to have unsupervised access to children, 8
vulnerable adults, or individuals with mental illness or 9
developmental disabilities if the applicant is otherwise qualified 10
and suitable; or 11
(ii) Disqualify the applicant solely based on the applicant's 12
criminal history. 13
(d) If the practice of a profession or business involves 14
unsupervised contact with vulnerable adults, children, or individuals 15
with mental illness or developmental disabilities, or populations 16
otherwise defined by statute as vulnerable, the department of health 17
may, after review of relevant factors, including the nature and 18
seriousness of the offense, time that has passed since conviction, 19
changed circumstances since the offense occurred, and the nature of 20
the employment or license sought, at its discretion:21
(i) Disqualify an applicant who has obtained a certificate of 22
restoration of opportunity, for a license, certification, or 23
registration to engage in the practice of a health care profession or 24
business solely based on the applicant's criminal history; or25
(ii) If such applicant is otherwise qualified and suitable, 26
credential or credential with conditions an applicant who has 27
obtained a certificate of restoration of opportunity for a license, 28
certification, or registration to engage in the practice of a health 29
care profession or business. 30
(e) The state of Washington, any of its counties, cities, towns, 31
municipal corporations, or quasi-municipal corporations, the 32
department of health, the department of social and health services, 33
and its officers, employees, contractors, and agents are immune from 34
suit in law, equity, or any action under the administrative procedure 35
act based upon its exercise of discretion under this section. This 36
section does not create a protected class; private right of action; 37
any right, privilege, or duty; or change to any right, privilege, or 38
duty existing under law. This section does not modify a licensing or 39
certification applicant's right to a review of an agency's decision 40
p. 34 HB 2127
under the administrative procedure act or other applicable statute or 1
agency rule. A certificate of restoration of opportunity does not 2
remove or alter citizenship or legal residency requirements already 3
in place for state agencies and employers. 4
(2) A qualified court has jurisdiction to issue a certificate of 5
restoration of opportunity to a qualified applicant.6
(a) A court must determine, in its discretion whether the 7
certificate: 8
(i) Applies to all past criminal history; or 9
(ii) Applies only to the convictions or adjudications in the 10
jurisdiction of the court. 11
(b) The certificate does not apply to any future criminal justice 12
involvement that occurs after the certificate is issued.13
(c) A court must determine whether to issue a certificate by 14
determining whether the applicant is a qualified applicant as defined 15
in RCW 9.97.010. 16
(3) An employer or housing provider may, in its sole discretion, 17
determine whether to consider a certificate of restoration of 18
opportunity issued under this chapter in making employment or rental 19
decisions. An employer or housing provider is immune from suit in 20
law, equity, or under the administrative procedure act for damages 21
based upon its exercise of discretion under this section or the 22
refusal to exercise such discretion. In any action at law against an 23
employer or housing provider arising out of the employment of or 24
provision of housing to the recipient of a certificate of restoration 25
of opportunity, evidence of the crime for which a certificate of 26
restoration of opportunity has been issued may not be introduced as 27
evidence of negligence or intentionally tortious conduct on the part 28
of the employer or housing provider. This subsection does not create 29
a protected class, private right of action, any right, privilege, or 30
duty, or to change any right, privilege, or duty existing under law 31
related to employment or housing except as provided in RCW 7.60.035.32
(4) The department of social and health services, and contracted 33
providers and licensees as defined in RCW 43.20A.715, when hiring, 34
licensing, certifying, contracting with, permitting, or continuing to 35
permit a person to be employed in any position caring for or having 36
unsupervised access to vulnerable adults or children, may, in their 37
sole discretion, determine whether to consider a certificate of 38
restoration of opportunity issued under this chapter. If the 39
department or a consumer directed employer as defined in RCW 40
p. 35 HB 2127
74.39A.009 determines that an individual with a certificate of 1
restoration of opportunity is qualified to work as an individual 2
provider as defined in RCW 74.39A.240, the department or the consumer 3
directed employer must provide the client, and their guardian if any, 4
with the results of the state background check for their 5
determination of character, suitability, and competence of the 6
individual before the individual begins providing services. The 7
department of social and health services, or contracted providers or 8
licensees as defined in RCW 43.20A.715, when hiring, licensing, 9
certifying, contracting with, permitting, or continuing to permit a 10
person to be employed in any position caring for or having 11
unsupervised access to vulnerable adults or children, have a 12
rebuttable presumption that their exercise of discretion under this 13
subsection or the refusal to exercise such discretion was 14
appropriate. This subsection does not create a protected class, a 15
private right of action, or any right, privilege, or duty, or to 16
change any right, privilege, or duty existing under law related to 17
the department of social and health services, contracted providers, 18
and licensees as defined in RCW 43.20A.715. 19
(5)(a) Department of social and health services: A certificate of 20
restoration of opportunity does not apply to the state abuse and 21
neglect registry. No finding of abuse, neglect, or misappropriation 22
of property may be removed from the registry based solely on a 23
certificate. The department must include such certificates as part of 24
its criminal history record reports, qualifying letters, or other 25
assessments pursuant to RCW 43.43.830 through 43.43.838. The 26
department shall adopt rules to implement this subsection.27
(b) Washington state patrol: The Washington state patrol is not 28
required to remove any records based solely on a certificate of 29
restoration of opportunity. The state patrol must include a 30
certificate as part of its criminal history record report.31
(c) Court records: 32
(i) A certificate of restoration of opportunity has no effect on 33
any other court records, including records in the judicial 34
information system. The court records related to a certificate of 35
restoration of opportunity must be processed and recorded in the same 36
manner as any other record. 37
(ii) The qualified court where the applicant seeks the 38
certificate of restoration of opportunity must administer the court 39
p. 36 HB 2127
records regarding the certificate in the same manner as it does 1
regarding all other proceedings. 2
(d) Effect in other judicial proceedings: A certificate of 3
restoration of opportunity may only be submitted to a court to 4
demonstrate that the individual met the specific requirements of this 5
section and not for any other procedure, including evidence of 6
character, reputation, or conduct. A certificate is not an equivalent 7
procedure under Rule of Evidence 609(c). 8
(e) Department of health: The department of health must include a 9
certificate of restoration of opportunity on its public website if:10
(i) Its website includes an order, stipulation to informal 11
disposition, or notice of decision related to the conviction 12
identified in the certificate of restoration of opportunity; and13
(ii) The credential holder has provided a certified copy of the 14
certificate of restoration of opportunity to the department of 15
health. 16
(f) Department of children, youth, and families: A certificate of 17
restoration of opportunity does not apply to founded findings of 18
child abuse or neglect. No finding of child abuse or neglect may be 19
destroyed based solely on a certificate. The department of children, 20
youth, and families must include such certificates as part of its 21
criminal history record reports, qualifying letters, or other 22
assessments pursuant to RCW 43.43.830 through 43.43.838. The 23
department of children, youth, and families shall adopt rules to 24
implement this subsection (5)(f). 25
(6) In all cases, an applicant must provide notice to the 26
prosecutor in the county where he or she seeks a certificate of 27
restoration of opportunity of the pendency of such application. If 28
the applicant has been sentenced by any other jurisdiction in the 29
five years preceding the application for a certificate, the applicant 30
must also notify the prosecuting attorney in those jurisdictions. The 31
prosecutor in the county where an applicant applies for a certificate 32
shall provide the court with a report of the applicant's criminal 33
history. 34
(7) Application for a certificate of restoration of opportunity 35
must be filed as a civil action. 36
(8) A superior court in the county in which the applicant resides 37
may decline to consider the application for certificate of 38
restoration of opportunity. If the superior court in which the 39
applicant resides declines to consider the application, the court 40
p. 37 HB 2127
must dismiss the application without prejudice and the applicant may 1
refile the application in another qualified court. The court must 2
state the reason for the dismissal on the order. If the court 3
determines that the applicant does not meet the required 4
qualifications, then the court must dismiss the application without 5
prejudice and state the reason (s) on the order. The superior court in 6
the county of the applicant's conviction or adjudication may not 7
decline to consider the application. 8
(9) Unless the qualified court determines that a hearing on an 9
application for certificate of restoration is necessary, the court 10
must decide without a hearing whether to grant the certificate of 11
restoration of opportunity based on a review of the application filed 12
by the applicant and pleadings filed by the prosecuting attorney.13
(10) The clerk of the court in which the certificate of 14
restoration of opportunity is granted shall transmit the certificate 15
of restoration of opportunity to the Washington state patrol 16
identification section, which holds criminal history information for 17
the person who is the subject of the conviction. The Washington state 18
patrol shall update its records to reflect the certificate of 19
restoration of opportunity. 20
(11)(a) The administrative office of the courts shall develop and 21
prepare instructions, forms, and an informational brochure designed 22
to assist applicants applying for a certificate of restoration of 23
opportunity. 24
(b) The instructions must include, at least, a sample of a 25
standard application and a form order for a certificate of 26
restoration of opportunity. 27
(c) The administrative office of the courts shall distribute a 28
master copy of the instructions, informational brochure, and sample 29
application and form order to all county clerks and a master copy of 30
the application and order to all superior courts by January 1, 2017.31
(d) The administrative office of the courts shall determine the 32
significant non-English-speaking or limited English-speaking 33
populations in the state. The administrator shall then arrange for 34
translation of the instructions, which shall contain a sample of the 35
standard application and order, and the informational brochure into 36
languages spoken by those significant non-English-speaking 37
populations and shall distribute a master copy of the translated 38
instructions and informational brochures to the county clerks by 39
January 1, 2017. 40
p. 38 HB 2127
(e) The administrative office of the courts shall update the 1
instructions, brochures, standard application and order, and 2
translations when changes in the law make an update necessary.3
Sec. 27. RCW 10.77.575 and 2025 c 58 s 5066 are each amended to 4
read as follows: 5
(1) Conditional release planning should start at admission and 6
proceed in coordination between the department and the person's 7
managed care organization, or behavioral health administrative 8
services organization if the person is not eligible for medical 9
assistance under chapter 74.09 RCW. If needed, the department shall 10
assist the person to enroll in medical assistance in suspense status 11
under RCW 74.09.670. The state hospital liaison for the managed care 12
organization or behavioral health administrative services 13
organization shall facilitate conditional release planning in 14
collaboration with the department. 15
(2) Less restrictive alternative treatment pursuant to a 16
conditional release order, at a minimum, includes the following 17
services: 18
(a) Assignment of a care coordinator; 19
(b) An intake evaluation with the provider of the conditional 20
treatment; 21
(c) A psychiatric evaluation or a substance use disorder 22
evaluation, or both; 23
(d) A schedule of regular contacts with the provider of the less 24
restrictive alternative treatment services for the duration of the 25
order; 26
(e) A transition plan addressing access to continued services at 27
the expiration of the order; 28
(f) An individual crisis plan; 29
(g) Consultation about the formation of a mental health advance 30
directive under chapter 71.32 RCW; 31
(h) Appointment of a transition team under RCW 10.77.550; and32
(i) Notification to the care coordinator assigned in (a) of this 33
subsection and to the transition team as provided in RCW 10.77.550 if 34
reasonable efforts to engage the client fail to produce substantial 35
compliance with court-ordered treatment conditions.36
(3) Less restrictive alternative treatment pursuant to a 37
conditional release order may additionally include requirements to 38
participate in the following services: 39
p. 39 HB 2127
(a) Medication management; 1
(b) Psychotherapy; 2
(c) Nursing; 3
(d) Substance use disorder counseling; 4
(e) Residential treatment; 5
(f) Partial hospitalization; 6
(g) Intensive outpatient treatment; 7
(h) Support for housing, benefits, education, and employment; and8
(i) Periodic court review. 9
(4) Nothing in this section prohibits items in subsection (2) of 10
this section from beginning before the conditional release of the 11
individual. 12
(5) If the person was provided with involuntary medication under 13
RCW 10.77.525 or pursuant to a judicial order during the involuntary 14
commitment period, the less restrictive alternative treatment 15
pursuant to the conditional release order may authorize the less 16
restrictive alternative treatment provider or its designee to 17
administer involuntary antipsychotic medication to the person if the 18
provider has attempted and failed to obtain the informed consent of 19
the person and there is a concurring medical opinion approving the 20
medication by a psychiatrist, physician ((assistant)) associate 21
working with a psychiatrist who is acting as a participating 22
physician as defined in RCW 18.71A.010, psychiatric advanced practice 23
registered nurse, or physician or physician ((assistant)) associate 24
in consultation with an independent mental health professional with 25
prescribing authority. 26
(6) Less restrictive alternative treatment pursuant to a 27
conditional release order must be administered by a provider that is 28
certified or licensed to provide or coordinate the full scope of 29
services required under the less restrictive alternative order and 30
that has agreed to assume this responsibility. 31
(7) The care coordinator assigned to a person ordered to less 32
restrictive alternative treatment pursuant to a conditional release 33
order must submit an individualized plan for the person's treatment 34
services to the court that entered the order. An initial plan must be 35
submitted as soon as possible following the intake evaluation and a 36
revised plan must be submitted upon any subsequent modification in 37
which a type of service is removed from or added to the treatment 38
plan. 39
p. 40 HB 2127
(8) A care coordinator may disclose information and records 1
related to mental health treatment under RCW 70.02.230(2)(k) for 2
purposes of implementing less restrictive alternative treatment 3
pursuant to a conditional release order. 4
(9) For the purpose of this section, "care coordinator" means a 5
representative from the department of social and health services who 6
coordinates the activities of less restrictive alternative treatment 7
pursuant to a conditional release order. The care coordinator 8
coordinates activities with the person's transition team that are 9
necessary for enforcement and continuation of the conditional release 10
order and is responsible for coordinating service activities with 11
other agencies and establishing and maintaining a therapeutic 12
relationship with the individual on a continuing basis.13
Sec. 28. RCW 11.130.290 and 2025 c 58 s 5067 are each amended to 14
read as follows: 15
(1) On receipt of a petition under RCW 11.130.270 and at the time 16
the court appoints a court visitor under RCW 11.130.280, the court 17
shall order a professional evaluation of the respondent.18
(2) The respondent must be examined by a physician licensed to 19
practice under chapter 18.71 or 18.57 RCW, psychologist licensed 20
under chapter 18.83 RCW, advanced practice registered nurse licensed 21
under chapter 18.79 RCW, or physician ((assistant)) associate 22
licensed under chapter 18.71A RCW selected by the court visitor who 23
is qualified to evaluate the respondent's alleged cognitive and 24
functional abilities and limitations and will not be advantaged or 25
disadvantaged by a decision to grant the petition or otherwise have a 26
conflict of interest. If the respondent opposes the professional 27
selected by the court visitor, the court visitor shall obtain a 28
professional evaluation from the professional selected by the 29
respondent. The court visitor, after receiving a professional 30
evaluation from the individual selected by the respondent, may obtain 31
a supplemental evaluation from a different professional.32
(3) The individual conducting the evaluation shall provide the 33
completed evaluation report to the court visitor within thirty days 34
of the examination of the respondent. The court visitor shall file 35
the report in a sealed record with the court. Unless otherwise 36
directed by the court, the report must contain: 37
(a) The professional's name, address, education, and experience;38
p. 41 HB 2127
(b) A description of the nature, type, and extent of the 1
respondent's cognitive and functional abilities and limitations;2
(c) An evaluation of the respondent's mental and physical 3
condition and, if appropriate, educational potential, adaptive 4
behavior, and social skills; 5
(d) A prognosis for improvement and recommendation for the 6
appropriate treatment, support, or habilitation plan;7
(e) A description of the respondent's current medications, and 8
the effect of the medications on the respondent's cognitive and 9
functional abilities; 10
(f) Identification or persons with whom the professional has met 11
or spoken with regarding the respondent; and 12
(g) The date of the examination on which the report is based.13
(4) If the respondent declines to participate in an evaluation 14
ordered under subsection (1) of this section, the court may proceed 15
with the hearing under RCW 11.130.275 if the court finds that it has 16
sufficient information to determine the respondent's needs and 17
abilities without the professional evaluation. 18
Sec. 29. RCW 11.130.390 and 2025 c 58 s 5068 are each amended to 19
read as follows: 20
(1) On receipt of a petition under RCW 11.130.360 and at the time 21
the court appoints a court visitor under RCW 11.130.380, the court 22
shall order a professional evaluation of the respondent.23
(2) The respondent must be examined by a physician licensed to 24
practice under chapter 18.71 or 18.57 RCW, psychologist licensed 25
under chapter 18.83 RCW, advanced practice registered nurse licensed 26
under chapter 18.79 RCW, or physician ((assistant)) associate 27
licensed under chapter 18.71A RCW, selected by the court visitor who 28
is qualified to evaluate the respondent's alleged cognitive and 29
functional abilities and limitations and will not be advantaged or 30
disadvantaged by a decision to grant the petition or otherwise have a 31
conflict of interest. If the respondent opposes the professional 32
selected by the court visitor, the court visitor shall obtain a 33
professional evaluation from the professional selected by the 34
respondent. The court visitor, after receiving a professional 35
evaluation from the individual selected by the respondent, may obtain 36
a supplemental evaluation from a different professional.37
(3) The individual conducting the evaluation shall promptly 38
provide the completed evaluation report to the court visitor who 39
p. 42 HB 2127
shall file the report in a sealed record with the court. Unless 1
otherwise directed by the court, the report must contain:2
(a) The professional's name, address, education, and experience;3
(b) A description of the nature, type, and extent of the 4
respondent's cognitive and functional abilities and limitations with 5
regard to the management of the respondent's property and financial 6
affairs; 7
(c) An evaluation of the respondent's mental and physical 8
condition and, if appropriate, educational potential, adaptive 9
behavior, and social skills; 10
(d) A prognosis for improvement with regard to the ability to 11
manage the respondent's property and financial affairs;12
(e) A description of the respondent's current medications, and 13
the effect of the medications on the respondent's cognitive and 14
functional abilities; 15
(f) Identification or persons with whom the professional has met 16
or spoken with regarding the respondent; and 17
(g) The date of the examination on which the report is based.18
(4) If the respondent declines to participate in an evaluation 19
ordered under subsection (1) of this section, the court may proceed 20
with the hearing under RCW 11.130.370 if the court finds that it has 21
sufficient information to determine the respondent's needs and 22
abilities without the professional evaluation. 23
(5) A professional evaluation is not required if a petition for 24
appointment of a conservator under RCW 11.130.360 is for a 25
conservator for the property or financial affairs of a minor or for 26
an adult missing, detained, or unable to return to the United States.27
Sec. 30. RCW 11.130.615 and 2025 c 58 s 5069 are each amended to 28
read as follows: 29
(1) On receipt of a petition under RCW 11.130.595 and at the time 30
the court appoints a court visitor under RCW 11.130.605, the court 31
shall order a professional evaluation of the respondent.32
(2) The respondent must be examined by a physician licensed to 33
practice under chapter 18.71 or 18.57 RCW, psychologist licensed 34
under chapter 18.83 RCW, advanced practice registered nurse licensed 35
under chapter 18.79 RCW, or physician ((assistant)) associate 36
licensed under chapter 18.71A RCW selected by the court visitor who 37
is qualified to evaluate the respondent's alleged cognitive and 38
functional abilities and limitations and will not be advantaged or 39
p. 43 HB 2127
disadvantaged by a decision to grant the petition or otherwise have a 1
conflict of interest. If the respondent opposes the professional 2
selected by the court visitor, the court visitor shall obtain a 3
professional evaluation from the professional selected by the 4
respondent. The court visitor, after receiving a professional 5
evaluation from the individual selected by the respondent, may obtain 6
a supplemental evaluation from a different professional.7
(3) The individual conducting the evaluation shall provide the 8
completed evaluation report to the court visitor within thirty days 9
of the examination of the respondent. The court visitor shall file 10
the report in a sealed record with the court. Unless otherwise 11
directed by the court, the report must contain: 12
(a) The professional's name, address, education, and experience;13
(b) A description of the nature, type, and extent of the 14
respondent's cognitive and functional abilities and limitations;15
(c) An evaluation of the respondent's mental and physical 16
condition and, if appropriate, education potential, adaptive 17
behavior, and social skills; 18
(d) A prognosis for improvement and recommendation for the 19
appropriate treatment, support, or habilitation plan;20
(e) A description of the respondent's current medications, and 21
the effect of the medications on the respondent's cognitive and 22
functional abilities; 23
(f) Identification or persons with whom the professional has met 24
or spoken with regarding the respondent; and 25
(g) The date of the examination on which the report is based.26
(4) If the respondent declines to participate in an evaluation 27
ordered under subsection (1) of this section, the court may proceed 28
with the hearing under RCW 11.130.600 if the court finds that it has 29
sufficient information to determine the respondent's needs and 30
abilities without the professional evaluation. 31
Sec. 31. RCW 18.16.260 and 2025 c 58 s 5070 are each amended to 32
read as follows: 33
(1)(a) Prior to July 1, 2005, (i) a cosmetology licensee who held 34
a license in good standing between June 30, 1999, and June 30, 2003, 35
may request a renewal of the license or an additional license in 36
barbering, manicuring, and/or esthetics; and (ii) a licensee who held 37
a barber, manicurist, or esthetics license between June 30, 1999, and 38
p. 44 HB 2127
June 30, 2003, may request a renewal of such licenses held during 1
that period. 2
(b) A license renewal fee, including, if applicable, a renewal 3
fee, at the current rate, for each year the licensee did not hold a 4
license in good standing between July 1, 2001, and the date of the 5
renewal request, must be paid prior to issuance of each type of 6
license requested. After June 30, 2005, any cosmetology licensee 7
wishing to renew an expired license or obtain additional licenses 8
must meet the applicable renewal, training, and examination 9
requirements of this chapter. 10
(2)(a) Any person holding an active license in good standing as 11
an esthetician prior to January 1, 2015, may be licensed as an 12
esthetician licensee after paying the appropriate license fee.13
(b) Prior to January 1, 2015, an applicant for a master 14
esthetician license must have an active license in good standing as 15
an esthetician, pay the appropriate license fee, and provide the 16
department with proof of having satisfied one or more of the 17
following requirements: 18
(i)(A)(I) A minimum of thirty-five hours employment as a provider 19
of medium depth peels under the delegation or supervision of a 20
licensed physician, advanced practice registered nurse, or physician 21
((assistant)) associate, or other licensed professional whose 22
licensure permits such delegation or supervision; or23
(II) Seven hours of training in theory and application of medium 24
depth peels; and 25
(B)(I) A minimum of one hundred fifty hours employment as a laser 26
operator under the delegation or supervision of a licensed physician, 27
advanced practice registered nurse, or physician ((assistant)) 28
associate, or other licensed professional whose licensure permits 29
such delegation or supervision; or 30
(II) Seventy-five hours of laser training; 31
(ii) A national or international diploma or certification in 32
esthetics that is recognized by the department by rule;33
(iii) An instructor in esthetics who has been licensed as an 34
instructor in esthetics by the department for a minimum of three 35
years; or 36
(iv) Completion of one thousand two hundred hours of an esthetic 37
curriculum approved by the department. 38
p. 45 HB 2127
(3) The director may, as provided in RCW 43.24.140, modify the 1
duration of any additional license granted under this section to make 2
all licenses issued to a person expire on the same date.3
Sec. 32. RCW 18.50.005 and 2025 c 58 s 5071 are each amended to 4
read as follows: 5
Unless the context clearly requires otherwise, the definitions in 6
this section apply throughout this chapter: 7
(1) "Advanced practice registered nurse" means an advanced 8
practice registered nurse licensed under chapter 18.79 RCW.9
(2) "Department" means the department of health.10
(3) "Secretary" means the secretary of health.11
(4) "Midwife" means a midwife licensed under this chapter.12
(5) "Naturopath" means a naturopath licensed under chapter 18.36A 13
RCW. 14
(6) "Physician" means a physician licensed under chapter 18.57 or 15
18.71 RCW. 16
(7) "Physician ((assistant)) associate" means a physician 17
((assistant)) associate licensed under chapter 18.71A RCW.18
Sec. 33. RCW 18.50.115 and 2025 c 58 s 5072 are each amended to 19
read as follows: 20
(1) A midwife licensed under this chapter may obtain and 21
administer prophylactic ophthalmic medication, postpartum oxytocic, 22
vitamin K, Rho immune globulin (human), and local anesthetic and may 23
administer such other drugs or medications as prescribed by a 24
physician, an advanced practice registered nurse, a naturopath, or a 25
physician ((assistant)) associate acting within the practitioner's 26
scope of practice. A pharmacist who dispenses such drugs to a 27
licensed midwife shall not be liable for any adverse reactions caused 28
by any method of use by the midwife. 29
(2) A midwife licensed under this chapter who has been granted a 30
limited prescriptive license extension by the secretary may 31
prescribe, obtain, and administer: 32
(a) Antibiotic, antiemetic, antiviral, antifungal, low-potency 33
topical steroid, and antipruritic medications and therapies, and 34
other medications and therapies as defined in the midwifery legend 35
drugs and devices rule for the prevention and treatment of conditions 36
that do not constitute a significant deviation from normal in 37
pregnancy or postpartum; and 38
p. 46 HB 2127
(b) Hormonal and nonhormonal family planning methods.1
(3) A midwife licensed under this chapter who has been granted an 2
additional license extension to include medical devices and implants 3
by the secretary may prescribe, obtain, and administer hormonal and 4
nonhormonal family planning medical devices, as prescribed in rule.5
(4) The secretary, after collaboration with representatives of 6
the midwifery advisory committee, the pharmacy quality assurance 7
commission, and the Washington medical commission, may adopt rules 8
that authorize licensed midwives to prescribe, obtain, and administer 9
legend drugs and devices in addition to the drugs authorized in this 10
chapter. 11
Sec. 34. RCW 18.57.040 and 2025 c 58 s 5073 are each amended to 12
read as follows: 13
Nothing in this chapter shall be construed to prohibit:14
(1) Service in the case of emergency; 15
(2) The domestic administration of family remedies;16
(3) The practice of midwifery as permitted under chapter 18.50 17
RCW; 18
(4) The practice of osteopathic medicine and surgery by any 19
commissioned medical officer in the United States government or 20
military service or by any osteopathic physician and surgeon employed 21
by a federal agency, in the discharge of his or her official duties;22
(5) Practice by a dentist licensed under chapter 18.32 RCW when 23
engaged exclusively in the practice of dentistry; 24
(6) The consultation through telemedicine or other means by a 25
practitioner, licensed by another state or territory in which he or 26
she resides, with a practitioner licensed in this state who has 27
responsibility for the diagnosis and treatment of the patient within 28
this state; 29
(7) In-person practice by any osteopathic physician and surgeon 30
from any other state or territory in which he or she resides: 31
PROVIDED, That such practitioner shall not open an office or appoint 32
a place of meeting patients or receive calls within the limits of 33
this state; 34
(8) Practice by a person who is a student enrolled in an 35
accredited school of osteopathic medicine and surgery approved by the 36
board if: 37
(a) The performance of such services is only pursuant to a course 38
of instruction or assignments from his or her instructor or school, 39
p. 47 HB 2127
and such services are performed only under the supervision of a 1
person licensed pursuant to this chapter or chapter 18.71 RCW; or2
(b)(i) Such services are performed without compensation or 3
expectation of compensation as part of a volunteer activity;4
(ii) The student is under the direct supervision and control of a 5
pharmacist licensed under chapter 18.64 RCW, a physician licensed 6
under chapter 18.71 RCW, an osteopathic physician and surgeon 7
licensed under this chapter, or a registered nurse or advanced 8
practice registered nurse licensed under chapter 18.79 RCW;9
(iii) The services the student performs are within the scope of 10
practice of: (A) An osteopathic physician and surgeon licensed under 11
this chapter; and (B) the person supervising the student;12
(iv) The school in which the student is enrolled verifies the 13
student has demonstrated competency through his or her education and 14
training to perform the services; and 15
(v) The student provides proof of current malpractice insurance 16
to the volunteer activity organizer prior to performing any services;17
(9) Practice by an osteopathic physician and surgeon serving a 18
period of clinical postgraduate medical training in a postgraduate 19
program approved by the board: PROVIDED, That the performance of such 20
services be only pursuant to a course of instruction in said program, 21
and said services are performed only under the supervision and 22
control of a person licensed pursuant to this chapter or chapter 23
18.71 RCW; or 24
(10) Practice by a person who is enrolled in a physician 25
((assistant)) associate program approved by the board who is 26
performing such services only pursuant to a course of instruction in 27
said program: PROVIDED, That such services are performed only under 28
the supervision and control of a person licensed pursuant to this 29
chapter or chapter 18.71 RCW. 30
This chapter shall not be construed to apply in any manner to any 31
other system or method of treating the sick or afflicted or to apply 32
to or interfere in any way with the practice of religion or any kind 33
of treatment by prayer. 34
Sec. 35. RCW 18.59.100 and 2025 c 58 s 5074 are each amended to 35
read as follows: 36
An occupational therapist shall, after evaluating a patient and 37
if the case is a medical one, refer the case to a physician for 38
appropriate medical direction if such direction is lacking. Treatment 39
p. 48 HB 2127
by an occupational therapist of such a medical case may take place 1
only upon the referral of a physician, osteopathic physician, 2
podiatric physician and surgeon, naturopath, chiropractor, physician 3
((assistant)) associate, psychologist, optometrist, or advanced 4
practice registered nurse licensed to practice in this state.5
Sec. 36. RCW 18.71.015 and 2022 c 240 s 34 are each amended to 6
read as follows: 7
The Washington medical commission is established, consisting of 8
thirteen individuals licensed to practice medicine in the state of 9
Washington under this chapter, two individuals who are licensed in 10
the state of Washington as physician ((assistants)) associates under 11
chapter 18.71A RCW, and six individuals who are members of the 12
public. At least two of the public members shall not be from the 13
health care industry. Each congressional district now existing or 14
hereafter created in the state must be represented by at least one 15
physician member of the commission. The terms of office of members of 16
the commission are not affected by changes in congressional district 17
boundaries. Public members of the commission may not be a member of 18
any other health care licensing board or commission, or have a 19
fiduciary obligation to a facility rendering health services 20
regulated by the commission, or have a material or financial interest 21
in the rendering of health services regulated by the commission.22
The members of the commission shall be appointed by the governor, 23
and all terms of appointment shall be for four years. The governor 24
shall consider such physician and physician ((assistant)) associate 25
members who are recommended for appointment by the appropriate 26
professional associations in the state. No member may serve more than 27
two consecutive full terms. Each member shall hold office until a 28
successor is appointed. 29
Each member of the commission must be an actual resident of this 30
state, and, if a physician or physician ((assistant)) associate, must 31
have been licensed to practice medicine in this state for at least 32
five years. 33
The commission shall meet as soon as practicable after 34
appointment and elect officers each year. Meetings shall be held at 35
least four times a year and at such place as the commission 36
determines and at such other times and places as the commission deems 37
necessary. A majority of the commission members appointed and serving 38
constitutes a quorum for the transaction of commission business.39
p. 49 HB 2127
The affirmative vote of a majority of a quorum of the commission 1
is required to carry any motion or resolution, to adopt any rule, or 2
to pass any measure. The commission may appoint panels consisting of 3
at least three members. A quorum for the transaction of any business 4
by a panel is a minimum of three members. A majority vote of a quorum 5
of the panel is required to transact business delegated to it by the 6
commission. 7
Each member of the commission shall be compensated in accordance 8
with RCW 43.03.265 and in addition thereto shall be reimbursed for 9
travel expenses incurred in carrying out the duties of the commission 10
in accordance with RCW 43.03.050 and 43.03.060. Any such expenses 11
shall be paid from funds appropriated to the department of health.12
Whenever the governor is satisfied that a member of a commission 13
has been guilty of neglect of duty, misconduct, or malfeasance or 14
misfeasance in office, the governor shall file with the secretary of 15
state a statement of the causes for and the order of removal from 16
office, and the secretary shall forthwith send a certified copy of 17
the statement of causes and order of removal to the last known post 18
office address of the member. 19
Vacancies in the membership of the commission shall be filled for 20
the unexpired term by appointment by the governor.21
The members of the commission are immune from suit in an action, 22
civil or criminal, based on its disciplinary proceedings or other 23
official acts performed in good faith as members of the commission.24
Whenever the workload of the commission requires, the commission 25
may request that the secretary appoint pro tempore members of the 26
commission. When serving, pro tempore members of the commission have 27
all of the powers, duties, and immunities, and are entitled to all of 28
the emoluments, including travel expenses, of regularly appointed 29
members of the commission. 30
Sec. 37. RCW 18.71.030 and 2025 c 58 s 5077 are each amended to 31
read as follows: 32
Nothing in this chapter shall be construed to apply to or 33
interfere in any way with the practice of religion or any kind of 34
treatment by prayer; nor shall anything in this chapter be construed 35
to prohibit: 36
(1) The furnishing of medical assistance in cases of emergency 37
requiring immediate attention; 38
(2) The domestic administration of family remedies;39
p. 50 HB 2127
(3) The administration of oral medication of any nature to 1
students by public school district employees or private elementary or 2
secondary school employees as provided for in chapter 28A.210 RCW;3
(4) The practice of dentistry, osteopathic medicine and surgery, 4
nursing, chiropractic, podiatric medicine and surgery, optometry, 5
naturopathy, or any other healing art licensed under the methods or 6
means permitted by such license; 7
(5) The practice of medicine in this state by any commissioned 8
medical officer serving in the armed forces of the United States or 9
public health service or any medical officer on duty with the United 10
States veterans administration while such medical officer is engaged 11
in the performance of the duties prescribed for him or her by the 12
laws and regulations of the United States; 13
(6) The consultation through telemedicine or other means by a 14
practitioner, licensed by another state or territory in which he or 15
she resides, with a practitioner licensed in this state who has 16
responsibility for the diagnosis and treatment of the patient within 17
this state; 18
(7) The in-person practice of medicine by any practitioner 19
licensed by another state or territory in which he or she resides, 20
provided that such practitioner shall not open an office or appoint a 21
place of meeting patients or receiving calls within this state;22
(8) The practice of medicine by a person who is a regular student 23
in a school of medicine approved and accredited by the commission if:24
(a) The performance of such services is only pursuant to a 25
regular course of instruction or assignments from his or her 26
instructor; or 27
(b) Such services are performed only under the supervision and 28
control of a person licensed pursuant to this chapter; or29
(c)(i) Such services are performed without compensation or 30
expectation of compensation as part of a volunteer activity;31
(ii) The student is under the direct supervision and control of a 32
pharmacist licensed under chapter 18.64 RCW, an osteopathic physician 33
and surgeon licensed under chapter 18.57 RCW, or a registered nurse 34
or advanced practice registered nurse licensed under chapter 18.79 35
RCW; 36
(iii) The services the student performs are within the scope of 37
practice of: (A) A physician licensed under this chapter; and (B) the 38
person supervising the student; 39
p. 51 HB 2127
(iv) The school in which the student is enrolled verifies the 1
student has demonstrated competency through his or her education and 2
training to perform the services; and 3
(v) The student provides proof of current malpractice insurance 4
to the volunteer activity organizer prior to performing any services;5
(9) The practice of medicine by a person serving a period of 6
postgraduate medical training in a program of clinical medical 7
training sponsored by a college or university in this state or by a 8
hospital accredited in this state, however, the performance of such 9
services shall be only pursuant to his or her duties as a trainee;10
(10) The practice of medicine by a person who is regularly 11
enrolled in a physician ((assistant)) associate program approved by 12
the commission, however, the performance of such services shall be 13
only pursuant to a regular course of instruction in said program and 14
such services are performed only under the supervision and control of 15
a person licensed pursuant to this chapter; 16
(11) The practice of medicine by a licensed physician 17
((assistant)) associate which practice is performed under the 18
supervision of or in collaboration with a physician licensed pursuant 19
to this chapter; 20
(12) The practice of medicine, in any part of this state which 21
shares a common border with Canada and which is surrounded on three 22
sides by water, by a physician licensed to practice medicine and 23
surgery in Canada or any province or territory thereof;24
(13) The administration of nondental anesthesia by a dentist who 25
has completed a residency in anesthesiology at a school of medicine 26
approved by the commission, however, a dentist allowed to administer 27
nondental anesthesia shall do so only under authorization of the 28
patient's attending surgeon, obstetrician, or psychiatrist, and the 29
commission has jurisdiction to discipline a dentist practicing under 30
this exemption and enjoin or suspend such dentist from the practice 31
of nondental anesthesia according to this chapter and chapter 18.130 32
RCW; 33
(14) Emergency lifesaving service rendered by a physician's 34
trained advanced emergency medical technician and paramedic, as 35
defined in RCW 18.71.200, if the emergency lifesaving service is 36
rendered under the responsible supervision and control of a licensed 37
physician; 38
p. 52 HB 2127
(15) The provision of clean, intermittent bladder catheterization 1
for students by public school district employees or private school 2
employees as provided for in RCW 18.79.290 and 28A.210.280.3
Sec. 38. RCW 18.71.310 and 2024 c 15 s 2 are each amended to 4
read as follows: 5
(1) The commission shall enter into a contract with the entity to 6
implement a physician health program. The commission may enter into a 7
contract with the entity for up to six years in length. The physician 8
health program may include any or all of the following:9
(a) Entering into relationships supportive of the physician 10
health program with professionals who provide either evaluation or 11
treatment services, or both; 12
(b) Receiving and assessing reports of suspected impairment from 13
any source; 14
(c) Intervening in cases of verified impairment, or in cases 15
where there is reasonable cause to suspect impairment;16
(d) Upon reasonable cause, referring suspected or verified 17
impaired physicians for evaluation or treatment; 18
(e) Monitoring the treatment and rehabilitation of participants 19
including those ordered by the commission; 20
(f) Providing monitoring and care management support of program 21
participants; 22
(g) Performing such other activities as agreed upon by the 23
commission and the entity; and 24
(h) Providing prevention and education services.25
(2) A contract entered into under subsection (1) of this section 26
shall be financed by a surcharge of $70 per year or equivalent on 27
each license renewal or issuance of a new license to be collected by 28
the department of health from every physician, surgeon, and physician 29
((assistant)) associate licensed under this chapter in addition to 30
other license fees. These moneys shall be placed in the impaired 31
physician account to be used solely to support the physician health 32
program. 33
(3) All funds in the impaired physician account shall be paid to 34
the contract entity within sixty days of deposit. 35
Sec. 39. RCW 18.71.315 and 2022 c 43 s 6 are each amended to 36
read as follows: 37
p. 53 HB 2127
The impaired physician account is created in the custody of the 1
state treasurer. All receipts from RCW 18.71.310 from license 2
surcharges on physicians and physician ((assistants)) associates 3
shall be deposited into the account. Expenditures from the account 4
may only be used for the physician health program under this chapter. 5
Only the secretary of health or the secretary's designee may 6
authorize expenditures from the account. No appropriation is required 7
for expenditures from this account. 8
Sec. 40. RCW 18.71.360 and 1994 sp.s. c 9 s 334 are each amended 9
to read as follows: 10
To assist in identifying impairment related to alcohol abuse, the 11
commission may obtain a copy of the driving record of a physician or 12
a physician ((assistant)) associate maintained by the department of 13
licensing. 14
Sec. 41. RCW 18.71C.010 and 2024 c 53 s 2 are each amended to 15
read as follows: 16
In this compact: 17
(1) "Adverse action" means any administrative, civil, equitable, 18
or criminal action permitted by a state's laws which is imposed by a 19
licensing board or other authority against a physician assistant 20
license or license application or compact privilege such as license 21
denial, censure, revocation, suspension, probation, monitoring of the 22
licensee, or restriction on the licensee's practice.23
(2) "Compact privilege" means the authorization granted by a 24
remote state to allow a licensee from another participating state to 25
practice as a physician assistant to provide medical services and 26
other licensed activity to a patient located in the remote state 27
under the remote state's laws and regulations. 28
(3) "Conviction" means a finding by a court that an individual is 29
guilty of a felony or misdemeanor offense through adjudication or 30
entry of a plea of guilt or no contest to the charge by the offender.31
(4) "Criminal background check" means the submission of 32
fingerprints or other biometric-based information for a license 33
applicant for the purpose of obtaining that applicant's criminal 34
history record information, as defined in 28 C.F.R. Sec. 20.3 (d), 35
from the state's criminal history record repository as defined in 28 36
C.F.R. Sec. 20.3(f). 37
p. 54 HB 2127
(5) "Data system" means the repository of information about 1
licensees, including but not limited to license status and adverse 2
actions, which is created and administered under the terms of this 3
compact. 4
(6) "Executive committee" means a group of directors and ex 5
officio individuals elected or appointed pursuant to RCW 6
18.71C.060(6)(b). 7
(7) "Impaired practitioner" means a physician assistant whose 8
practice is adversely affected by health-related condition (s) that 9
impact their ability to practice. 10
(8) "Investigative information" means information, records, or 11
documents received or generated by a licensing board pursuant to an 12
investigation. 13
(9) "Jurisprudence requirement" means the assessment of an 14
individual's knowledge of the laws and rules governing the practice 15
of a physician assistant in a state. 16
(10) "License" means current authorization by a state, other than 17
authorization pursuant to a compact privilege, for a physician 18
assistant to provide medical services, which would be unlawful 19
without current authorization. 20
(11) "Licensee" means an individual who holds a license from a 21
state to provide medical services as a physician assistant.22
(12) "Licensing board" means any state entity authorized to 23
license and otherwise regulate physician assistants.24
(13) "Medical services" means health care services provided for 25
the diagnosis, prevention, treatment, cure or relief of a health 26
condition, injury, or disease, as defined by a state's laws and 27
regulations. 28
(14) "Model compact" means the model for the physician assistant 29
licensure compact on file with the council of state governments or 30
other entity as designated by the commission. 31
(15) "Participating state" means a state that has enacted this 32
compact. 33
(16) "Physician assistant" means an individual who is licensed as 34
a physician assistant in a state. For purposes of this compact, any 35
other title or status adopted by a state to replace the term 36
"physician assistant" shall be deemed synonymous with "physician 37
assistant" and shall confer the same rights and responsibilities to 38
the licensee under the provisions of this compact at the time of its 39
enactment. For the purposes of applying this compact to persons 40
p. 55 HB 2127
licensed in Washington, the term "physician assistant" means a 1
physician associate licensed under chapter 18.71A RCW.2
(17) "Physician assistant licensure compact commission," "compact 3
commission," or "commission" mean the national administrative body 4
created pursuant to RCW 18.71C.060(1). 5
(18) "Qualifying license" means an unrestricted license issued by 6
a participating state to provide medical services as a physician 7
assistant. 8
(19) "Remote state" means a participating state where a licensee 9
who is not licensed as a physician assistant is exercising or seeking 10
to exercise the compact privilege. 11
(20) "Rule" means a regulation promulgated by an entity that has 12
the force and effect of law. 13
(21) "Significant investigative information" means investigative 14
information that a licensing board, after an inquiry or investigation 15
that includes notification and an opportunity for the physician 16
assistant to respond if required by state law, has reason to believe 17
is not groundless and, if proven true, would indicate more than a 18
minor infraction. 19
(22) "State" means any state, commonwealth, district, or 20
territory of the United States. 21
Sec. 42. RCW 18.79.040 and 2024 c 239 s 2 are each amended to 22
read as follows: 23
(1) "Registered nursing practice" means the performance of acts 24
requiring substantial specialized knowledge, judgment, and skill 25
based on the principles of the biological, physiological, behavioral, 26
and sociological sciences in either: 27
(a) The observation, assessment, diagnosis, care or counsel, and 28
health teaching of individuals with illnesses, injuries, or 29
disabilities, or in the maintenance of health or prevention of 30
illness of others; 31
(b) The performance of such additional acts requiring education 32
and training and that are recognized by the medical and nursing 33
professions as proper and recognized by the board to be performed by 34
registered nurses licensed under this chapter and that are authorized 35
by the board through its rules; 36
(c) The administration, supervision, delegation, and evaluation 37
of nursing practice. However, nothing in this subsection affects the 38
authority of a hospital, hospital district, in-home service agency, 39
p. 56 HB 2127
community-based care setting, medical clinic, or office, concerning 1
its administration and supervision; 2
(d) The teaching of nursing; 3
(e) The executing of medical regimen as prescribed by a licensed 4
physician and surgeon, dentist, osteopathic physician and surgeon, 5
podiatric physician and surgeon, physician ((assistant)) associate, 6
or advanced practice registered nurse, or as directed by a licensed 7
midwife within his or her scope of practice. 8
(2) Nothing in this section prohibits a person from practicing a 9
profession for which a license has been issued under the laws of this 10
state or specifically authorized by any other law of the state of 11
Washington. 12
(3) This section does not prohibit (a) the nursing care of the 13
sick, without compensation, by an unlicensed person who does not hold 14
himself or herself out to be a registered nurse, (b) the practice of 15
licensed practical nursing by a licensed practical nurse, or (c) the 16
practice of a nursing assistant, providing delegated nursing tasks 17
under chapter 18.88A RCW. 18
Sec. 43. RCW 18.79.060 and 2024 c 239 s 4 are each amended to 19
read as follows: 20
"Licensed practical nursing practice" means the performance of 21
services requiring the knowledge, skill, and judgment necessary for 22
carrying out selected aspects of the designated nursing regimen under 23
the direction and supervision of a licensed physician and surgeon, 24
dentist, osteopathic physician and surgeon, physician ((assistant)) 25
associate, podiatric physician and surgeon, advanced practice 26
registered nurse, registered nurse, or midwife. 27
Nothing in this section prohibits a person from practicing a 28
profession for which a license has been issued under the laws of this 29
state or specifically authorized by any other law of the state of 30
Washington. 31
This section does not prohibit the nursing care of the sick, 32
without compensation, by an unlicensed person who does not hold 33
himself or herself out to be a licensed practical nurse.34
Sec. 44. RCW 18.79.260 and 2024 c 239 s 15 are each amended to 35
read as follows: 36
p. 57 HB 2127
(1) A registered nurse under his or her license may perform for 1
compensation nursing care, as that term is usually understood, to 2
individuals with illnesses, injuries, or disabilities.3
(2) A registered nurse may, at or under the general direction of 4
a licensed physician and surgeon, dentist, osteopathic physician and 5
surgeon, naturopathic physician, optometrist, podiatric physician and 6
surgeon, physician ((assistant)) associate, advanced practice 7
registered nurse, or midwife acting within the scope of his or her 8
license, administer medications, treatments, tests, and inoculations, 9
whether or not the severing or penetrating of tissues is involved and 10
whether or not a degree of independent judgment and skill is 11
required. Such direction must be for acts which are within the scope 12
of registered nursing practice. 13
(3) A registered nurse may delegate tasks of nursing care to 14
other individuals where the registered nurse determines that it is in 15
the best interest of the patient. 16
(a) The delegating nurse shall: 17
(i) Determine the competency of the individual to perform the 18
tasks; 19
(ii) Evaluate the appropriateness of the delegation;20
(iii) Supervise the actions of the person performing the 21
delegated task; and 22
(iv) Delegate only those tasks that are within the registered 23
nurse's scope of practice. 24
(b) A registered nurse, working for a home health or hospice 25
agency regulated under chapter 70.127 RCW, may delegate the 26
application, instillation, or insertion of medications to a 27
registered or certified nursing assistant under a plan of care.28
(c) Except as authorized in (b) or (e) of this subsection, a 29
registered nurse may not delegate the administration of medications. 30
Except as authorized in (e) or (f) of this subsection, a registered 31
nurse may not delegate acts requiring substantial skill, and may not 32
delegate piercing or severing of tissues. Acts that require nursing 33
judgment shall not be delegated. 34
(d) No person may coerce a nurse into compromising patient safety 35
by requiring the nurse to delegate if the nurse determines that it is 36
inappropriate to do so. Nurses shall not be subject to any employer 37
reprisal or disciplinary action by the board for refusing to delegate 38
tasks or refusing to provide the required training for delegation if 39
the nurse determines delegation may compromise patient safety.40
p. 58 HB 2127
(e) For delegation in community-based care settings or in-home 1
care settings, a registered nurse may delegate nursing care tasks 2
only to registered or certified nursing assistants under chapter 3
18.88A RCW or home care aides certified under chapter 18.88B RCW. 4
Simple care tasks such as blood pressure monitoring, personal care 5
service, diabetic insulin device set up, verbal verification of 6
insulin dosage for sight-impaired individuals, or other tasks as 7
defined by the board are exempted from this requirement.8
(i) "Community-based care settings" includes: Community 9
residential programs for people with developmental disabilities, 10
certified by the department of social and health services under 11
chapter 71A.12 RCW; adult family homes licensed under chapter 70.128 12
RCW; and assisted living facilities licensed under chapter 18.20 RCW. 13
Community-based care settings do not include acute care or skilled 14
nursing facilities. 15
(ii) "In-home care settings" include an individual's place of 16
temporary or permanent residence, but does not include acute care or 17
skilled nursing facilities, and does not include community-based care 18
settings as defined in (e)(i) of this subsection. 19
(iii) Delegation of nursing care tasks in community-based care 20
settings and in-home care settings is only allowed for individuals 21
who have a stable and predictable condition. "Stable and predictable 22
condition" means a situation in which the individual's clinical and 23
behavioral status is known and does not require the frequent presence 24
and evaluation of a registered nurse. 25
(iv) The determination of the appropriateness of delegation of a 26
nursing task is at the discretion of the registered nurse. Other than 27
delegation of the administration of insulin by injection for the 28
purpose of caring for individuals with diabetes, the administration 29
of medications by injection, sterile procedures, and central line 30
maintenance may never be delegated. 31
(v) When delegating insulin injections under this section, the 32
registered nurse delegator must instruct the individual regarding 33
proper injection procedures and the use of insulin, demonstrate 34
proper injection procedures, and must supervise and evaluate the 35
individual performing the delegated task as required by the board by 36
rule. If the registered nurse delegator determines that the 37
individual is competent to perform the injection properly and safely, 38
supervision and evaluation shall occur at an interval determined by 39
the board by rule. 40
p. 59 HB 2127
(vi)(A) The registered nurse shall verify that the nursing 1
assistant or home care aide, as the case may be, has completed the 2
required core nurse delegation training required in chapter 18.88A or 3
18.88B RCW prior to authorizing delegation. 4
(B) Before commencing any specific nursing tasks authorized to be 5
delegated in this section, a home care aide must be certified 6
pursuant to chapter 18.88B RCW and must comply with RCW 18.88B.070.7
(vii) The nurse is accountable for his or her own individual 8
actions in the delegation process. Nurses acting within the protocols 9
of their delegation authority are immune from liability for any 10
action performed in the course of their delegation duties.11
(viii) Nursing task delegation protocols are not intended to 12
regulate the settings in which delegation may occur, but are intended 13
to ensure that nursing care services have a consistent standard of 14
practice upon which the public and the profession may rely, and to 15
safeguard the authority of the nurse to make independent professional 16
decisions regarding the delegation of a task. 17
(f) The delegation of nursing care tasks only to registered or 18
certified nursing assistants under chapter 18.88A RCW or to home care 19
aides certified under chapter 18.88B RCW may include glucose 20
monitoring and testing. 21
(g) The board may adopt rules to implement this section.22
(4) Only a person licensed as a registered nurse may instruct 23
nurses in technical subjects pertaining to nursing.24
(5) Only a person licensed as a registered nurse may hold herself 25
or himself out to the public or designate herself or himself as a 26
registered nurse. 27
Sec. 45. RCW 18.79.270 and 2024 c 239 s 16 are each amended to 28
read as follows: 29
A licensed practical nurse under his or her license may perform 30
nursing care, as that term is usually understood, of the ill, 31
injured, or infirm, and in the course thereof may, under the 32
direction of a licensed physician and surgeon, osteopathic physician 33
and surgeon, dentist, naturopathic physician, podiatric physician and 34
surgeon, physician ((assistant)) associate, advanced practice 35
registered nurse, or midwife acting under the scope of his or her 36
license, or at the direction and under the supervision of a 37
registered nurse, administer drugs, medications, treatments, tests, 38
injections, and inoculations, whether or not the piercing of tissues 39
p. 60 HB 2127
is involved and whether or not a degree of independent judgment and 1
skill is required, when selected to do so by one of the licensed 2
practitioners designated in this section, or by a registered nurse 3
who need not be physically present; if the order given is reduced to 4
writing within a reasonable time and made a part of the patient's 5
record. Such direction must be for acts within the scope of licensed 6
practical nurse practice. 7
Sec. 46. RCW 18.89.020 and 2025 c 58 s 5079 are each amended to 8
read as follows: 9
Unless the context clearly requires otherwise, the definitions in 10
this section apply throughout this chapter. 11
(1) "Department" means the department of health.12
(2) "Direct supervision" means a health care practitioner is 13
continuously on-site and physically present in the treatment 14
operatory while the procedures are performed by the respiratory care 15
practitioner. 16
(3) "Health care practitioner" means: 17
(a) A physician licensed under chapter 18.71 RCW;18
(b) An osteopathic physician or surgeon licensed under chapter 19
18.57 RCW; or 20
(c) Acting within the scope of their respective licensure, a 21
podiatric physician and surgeon licensed under chapter 18.22 RCW, an 22
advanced practice registered nurse licensed under chapter 18.79 RCW, 23
a naturopath licensed under chapter 18.36A RCW, or a physician 24
((assistant)) associate licensed under chapter 18.71A RCW.25
(4) "Respiratory care practitioner" means an individual licensed 26
under this chapter. 27
(5) "Secretary" means the secretary of health or the secretary's 28
designee. 29
Sec. 47. RCW 18.130.020 and 2025 c 97 s 1 are each amended to 30
read as follows: 31
The definitions in this section apply throughout this chapter 32
unless the context clearly requires otherwise. 33
(1) "Board" means any of those boards specified in RCW 34
18.130.040. 35
(2) "Clinical expertise" means the proficiency or judgment that a 36
license holder in a particular profession acquires through clinical 37
p. 61 HB 2127
experience or clinical practice and that is not possessed by a lay 1
person. 2
(3) "Commission" means any of the commissions specified in RCW 3
18.130.040. 4
(4)(a) "Conversion therapy" means a regime that seeks to change 5
an individual's sexual orientation or gender identity. The term 6
includes efforts to change behaviors or gender expressions, or to 7
eliminate or reduce sexual or romantic attractions or feelings toward 8
individuals of the same sex. The term includes, but is not limited 9
to, practices commonly referred to as "reparative therapy."10
(b) "Conversion therapy" does not include counseling or 11
psychotherapies that provide acceptance, support, and understanding 12
of clients or the facilitation of clients' coping, social support, 13
and identity exploration and development that do not seek to change 14
sexual orientation or gender identity. 15
(5) "Department" means the department of health.16
(6) "Disciplinary action" means sanctions identified in RCW 17
18.130.160. 18
(7) "Disciplining authority" means the agency, board, or 19
commission having the authority to take disciplinary action against a 20
holder of, or applicant for, a professional or business license upon 21
a finding of a violation of this chapter or a chapter specified under 22
RCW 18.130.040. 23
(8) "Health agency" means city and county health departments and 24
the department of health. 25
(9) "License," "licensing," and "licensure" shall be deemed 26
equivalent to the terms "license," "licensing," "licensure," 27
"certificate," "certification," and "registration" as those terms are 28
defined in RCW 18.120.020. 29
(10)(a) "Physician well-being program" means a formal program 30
established for the purpose of addressing issues related to career 31
fatigue and well-being in physicians licensed under chapter 18.71 32
RCW, osteopathic physicians and surgeons licensed under chapter 18.57 33
RCW, physicians licensed under chapter 18.71B RCW, and physician 34
((assistants)) associates licensed under chapters 18.71A and 18.71C 35
RCW, that: 36
(i) Uses one-on-one, peer-to-peer interactions and connects 37
participants to physical and behavioral health resources and 38
professional supports when appropriate; 39
p. 62 HB 2127
(ii) Is limited to no more than three sessions per participant 1
every 12 months; 2
(iii) May include discussions pertaining to general career 3
fatigue and well-being arising from the physician's or physician 4
((assistant's)) associate's professional obligations, but not for 5
other purposes such as evaluation of specific care or harm of 6
specific patients, discipline, quality improvement, or the 7
identification and prevention of medical malpractice or misconduct of 8
specific providers; 9
(iv) Is established in writing and contracted for, in advance of 10
any peer-to-peer interactions or referrals, by an employer of 11
physicians and physician ((assistants)) associates, a nonprofit 12
professional medical organization representing a specialty of 13
physicians, or a statewide organization representing physicians and 14
physician ((assistants)) associates; 15
(v) Does not allow as participants any person employed by, or 16
with a financial ownership interest in, the program; and17
(vi) Does not include the monitoring of physicians or physician 18
((assistants)) associates who may be unable to practice medicine with 19
reasonable skill and safety. 20
(b) A quality improvement plan established under RCW 43.70.510 or 21
70.41.200 is not a physician well-being program for purposes of this 22
section. RCW 43.70.510 and 70.41.200 therefore do not apply to a 23
physician well-being program established under this section.24
(11) "Practice review" means an investigative audit of records 25
related to the complaint, without prior identification of specific 26
patient or consumer names, or an assessment of the conditions, 27
circumstances, and methods of the professional's practice related to 28
the complaint, to determine whether unprofessional conduct may have 29
been committed. 30
(12) "Secretary" means the secretary of health or the secretary's 31
designee. 32
(13) "Standards of practice" means the care, skill, and learning 33
associated with the practice of a profession. 34
(14) "Unlicensed practice" means: 35
(a) Practicing a profession or operating a business identified in 36
RCW 18.130.040 without holding a valid, unexpired, unrevoked, and 37
unsuspended license to do so; or 38
(b) Representing to a consumer, through offerings, 39
advertisements, or use of a professional title or designation, that 40
p. 63 HB 2127
the individual is qualified to practice a profession or operate a 1
business identified in RCW 18.130.040, without holding a valid, 2
unexpired, unrevoked, and unsuspended license to do so.3
Sec. 48. RCW 18.130.410 and 2025 c 58 s 5080 are each amended to 4
read as follows: 5
It is not professional misconduct for a physician licensed under 6
chapter 18.71 RCW; osteopathic physician licensed under chapter 18.57 7
RCW; registered nurse, licensed practical nurse, or advanced practice 8
registered nurse licensed under chapter 18.79 RCW; physician 9
((assistant)) associate licensed under chapter 18.71A RCW; advanced 10
emergency medical technician or paramedic certified under chapter 11
18.71 RCW; or medical assistant-certified, medical assistant-12
phlebotomist, or forensic phlebotomist certified under chapter 18.360 13
RCW, or person holding another credential under Title 18 RCW whose 14
scope of practice includes performing venous blood draws, or 15
hospital, or duly licensed clinical laboratory employing or utilizing 16
services of such licensed or certified health care provider, to 17
collect a blood sample without a person's consent when the physician 18
licensed under chapter 18.71 RCW; osteopathic physician licensed 19
under chapter 18.57 RCW; registered nurse, licensed practical nurse, 20
or advanced practice registered nurse licensed under chapter 18.79 21
RCW; physician ((assistant)) associate licensed under chapter 18.71A 22
RCW; advanced emergency medical technician or paramedic certified 23
under chapter 18.71 RCW; or medical assistant-certified, medical 24
assistant-phlebotomist, or forensic phlebotomist certified under 25
chapter 18.360 RCW, or person holding another credential under Title 26
18 RCW whose scope of practice includes performing venous blood 27
draws, or hospital, or duly licensed clinical laboratory employing or 28
utilizing services of such licensed or certified health care provider 29
withdrawing blood was directed by a law enforcement officer to do so 30
for the purpose of a blood test under the provisions of a search 31
warrant or exigent circumstances: PROVIDED, That nothing in this 32
section shall relieve a physician licensed under chapter 18.71 RCW; 33
osteopathic physician licensed under chapter 18.57 RCW; registered 34
nurse, licensed practical nurse, or advanced practice registered 35
nurse licensed under chapter 18.79 RCW; physician ((assistant)) 36
associate licensed under chapter 18.71A RCW; advanced emergency 37
medical technician or paramedic certified under chapter 18.71 RCW; or 38
medical assistant-certified, medical assistant-phlebotomist, or 39
p. 64 HB 2127
forensic phlebotomist certified under chapter 18.360 RCW, or person 1
holding another credential under Title 18 RCW whose scope of practice 2
includes performing venous blood draws, or hospital, or duly licensed 3
clinical laboratory employing or utilizing services of such licensed 4
or certified health care provider withdrawing blood from professional 5
discipline arising from the use of improper procedures or from 6
failing to exercise the required standard of care. 7
Sec. 49. RCW 18.134.010 and 2025 c 58 s 5081 are each amended to 8
read as follows: 9
The definitions in this section apply throughout this chapter 10
unless the context clearly requires otherwise. 11
(1) "Disciplining authority" means an entity to which a state has 12
granted the authority to license, certify, or discipline individuals 13
who provide health care. 14
(2) "Electronic" means relating to technology having electrical, 15
digital, magnetic, wireless, optical, electromagnetic, or similar 16
capabilities. 17
(3) "Health care" means care, treatment, or a service or 18
procedure, to maintain, monitor, diagnose, or otherwise affect an 19
individual's physical or behavioral health, injury, or condition.20
(4)(a) "Health care practitioner" means: 21
(i) A physician licensed under chapter 18.71 RCW;22
(ii) An osteopathic physician or surgeon licensed under chapter 23
18.57 RCW; 24
(iii) A podiatric physician and surgeon licensed under chapter 25
18.22 RCW; 26
(iv) An advanced practice registered nurse licensed under chapter 27
18.79 RCW; 28
(v) A naturopath licensed under chapter 18.36A RCW;29
(vi) A physician ((assistant)) associate licensed under chapter 30
18.71A RCW; or 31
(vii) A person who is otherwise authorized to practice a 32
profession regulated under the authority of RCW 18.130.040 to provide 33
health care in this state, to the extent the profession's scope of 34
practice includes health care that can be provided through 35
telehealth. 36
(b) "Health care practitioner" does not include a veterinarian 37
licensed under chapter 18.92 RCW. 38
(5) "Professional practice standard" includes:39
p. 65 HB 2127
(a) A standard of care; 1
(b) A standard of professional ethics; and 2
(c) A practice requirement imposed by a disciplining authority.3
(6) "Scope of practice" means the extent of a health care 4
practitioner's authority to provide health care. 5
(7) "State" means a state of the United States, the District of 6
Columbia, Puerto Rico, the United States Virgin Islands, or any other 7
territory or possession subject to the jurisdiction of the United 8
States. The term includes a federally recognized Indian tribe.9
(8) "Telecommunication technology" means technology that supports 10
communication through electronic means. The term is not limited to 11
regulated technology or technology associated with a regulated 12
industry. 13
(9) "Telehealth" includes telemedicine and means the use of 14
synchronous or asynchronous telecommunication technology by a 15
practitioner to provide health care to a patient at a different 16
physical location than the practitioner. "Telehealth" does not 17
include the use, in isolation, of email, instant messaging, text 18
messaging, or fax. 19
(10) "Telehealth services" means health care provided through 20
telehealth. 21
Sec. 50. RCW 18.250.010 and 2025 c 58 s 5083 are each amended to 22
read as follows: 23
The definitions in this section apply throughout this chapter 24
unless the context clearly requires otherwise. 25
(1) "Athlete" means a person who participates in exercise, 26
recreation, activities, sport, or games requiring physical strength, 27
range-of-motion, flexibility, body awareness and control, speed, 28
stamina, or agility, and the exercise, recreation, activities, 29
sports, or games are of a type conducted for the benefits of health 30
and wellness in association with an educational institution or 31
professional, amateur, recreational sports club or organization, 32
hospital, or industrial-based organization. 33
(2) "Athletic injury" means an injury or condition sustained by 34
an athlete that affects the person's participation or performance in 35
exercise, recreation, activities, sport, or games and the injury or 36
condition is within the professional preparation and education of an 37
athletic trainer. 38
p. 66 HB 2127
(3) "Athletic trainer" means a health care provider who is 1
licensed under this chapter. An athletic trainer can practice 2
athletic training through the consultation, referral, or guidelines 3
of a licensed health care provider as defined in subsection (7) of 4
this section working within their scope of practice.5
(4)(a) "Athletic training" means the application of the following 6
principles and methods as provided by a licensed athletic trainer:7
(i) Risk management and prevention of athletic injuries through 8
preactivity screening and evaluation, educational programs, physical 9
conditioning and reconditioning programs, application of commercial 10
products, use of protective equipment, promotion of healthy 11
behaviors, and reduction of environmental risks; 12
(ii) Recognition, evaluation, and assessment of athletic injuries 13
by obtaining a history of the athletic injury, inspection and 14
palpation of the injured part and associated structures, and 15
performance of specific testing techniques related to stability and 16
function to determine the extent of an injury; 17
(iii) Immediate care of athletic injuries, including emergency 18
medical situations through the application of first -aid and emergency 19
procedures and techniques for nonlife-threatening or life -threatening 20
athletic injuries; 21
(iv) Treatment, rehabilitation, and reconditioning of athletic 22
injuries through the application of physical agents and modalities, 23
therapeutic activities and exercise, standard reassessment techniques 24
and procedures, commercial products, and educational programs, in 25
accordance with guidelines established with a licensed health care 26
provider as provided in RCW 18.250.070; 27
(v) Treatment, rehabilitation, and reconditioning of work-related 28
injuries through the application of physical agents and modalities, 29
therapeutic activities and exercise, standard reassessment techniques 30
and procedures, commercial products, and educational programs, under 31
the direct supervision of and in accordance with a plan of care for 32
an individual worker established by a provider authorized to provide 33
physical medicine and rehabilitation services for injured workers; 34
and 35
(vi) Referral of an athlete to an appropriately licensed health 36
care provider if the athletic injury requires further definitive care 37
or the injury or condition is outside an athletic trainer's scope of 38
practice, in accordance with RCW 18.250.070. 39
(b) "Athletic training" does not include: 40
p. 67 HB 2127
(i) The use of spinal adjustment or manipulative mobilization of 1
the spine and its immediate articulations; 2
(ii) Orthotic or prosthetic services with the exception of 3
evaluation, measurement, fitting, and adjustment of temporary, 4
prefabricated or direct -formed orthosis as defined in chapter 18.200 5
RCW; 6
(iii) The practice of occupational therapy as defined in chapter 7
18.59 RCW; 8
(iv) The practice of acupuncture and Eastern medicine as defined 9
in chapter 18.06 RCW; 10
(v) Any medical diagnosis; and 11
(vi) Prescribing legend drugs or controlled substances, or 12
surgery. 13
(5) "Committee" means the athletic training advisory committee.14
(6) "Department" means the department of health.15
(7) "Licensed health care provider" means a physician, physician 16
((assistant)) associate, osteopathic physician, advanced practice 17
registered nurse, naturopath, physical therapist, chiropractor, 18
dentist, massage therapist, acupuncturist, occupational therapist, or 19
podiatric physician and surgeon. 20
(8) "Secretary" means the secretary of health or the secretary's 21
designee. 22
Sec. 51. RCW 18.360.010 and 2025 c 58 s 5084 are each amended to 23
read as follows: 24
The definitions in this section apply throughout this chapter 25
unless the context clearly requires otherwise. 26
(1) "Administer" means the retrieval of medication, and its 27
application to a patient, as authorized in RCW 18.360.050.28
(2) "Delegation" means direct authorization granted by a licensed 29
health care practitioner to a medical assistant to perform the 30
functions authorized in this chapter which fall within the scope of 31
practice of the health care provider and the training and experience 32
of the medical assistant. 33
(3) "Department" means the department of health.34
(4) "Forensic phlebotomist" means a police officer, law 35
enforcement officer, or employee of a correctional facility or 36
detention facility, who is certified under this chapter and meets any 37
additional training and proficiency standards of his or her employer 38
to collect a venous blood sample for forensic testing pursuant to a 39
p. 68 HB 2127
search warrant, a waiver of the warrant requirement, or exigent 1
circumstances. 2
(5) "Health care practitioner" means: 3
(a) A physician licensed under chapter 18.71 RCW;4
(b) An osteopathic physician and surgeon licensed under chapter 5
18.57 RCW; or 6
(c) Acting within the scope of their respective licensure, a 7
podiatric physician and surgeon licensed under chapter 18.22 RCW, a 8
registered nurse or advanced practice registered nurse licensed under 9
chapter 18.79 RCW, a naturopath licensed under chapter 18.36A RCW, a 10
physician ((assistant)) associate licensed under chapter 18.71A RCW, 11
or an optometrist licensed under chapter 18.53 RCW.12
(6) "Medical assistant-certified" means a person certified under 13
RCW 18.360.040 who assists a health care practitioner with patient 14
care, executes administrative and clinical procedures, and performs 15
functions as provided in RCW 18.360.050 under the supervision of the 16
health care practitioner. 17
(7) "Medical assistant-EMT" means a person certified under RCW 18
18.360.040 who performs functions as provided in RCW 18.360.050 under 19
the supervision of a health care practitioner and holds: An emergency 20
medical technician certification under RCW 18.73.081; an advanced 21
emergency medical technician certification under RCW 18.71.205; or a 22
paramedic certification under RCW 18.71.205. 23
(8) "Medical assistant-hemodialysis technician" means a person 24
certified under RCW 18.360.040 who performs hemodialysis and other 25
functions pursuant to RCW 18.360.050 under the supervision of a 26
health care practitioner. 27
(9) "Medical assistant-phlebotomist" means a person certified 28
under RCW 18.360.040 who performs capillary, venous, and arterial 29
invasive procedures for blood withdrawal and other functions pursuant 30
to RCW 18.360.050 under the supervision of a health care 31
practitioner. 32
(10) "Medical assistant-registered" means a person registered 33
under RCW 18.360.040 who, pursuant to an endorsement by a health care 34
practitioner, clinic, or group practice, assists a health care 35
practitioner with patient care, executes administrative and clinical 36
procedures, and performs functions as provided in RCW 18.360.050 37
under the supervision of the health care practitioner.38
(11) "Secretary" means the secretary of the department of health.39
p. 69 HB 2127
(12)(a) "Supervision" means supervision of procedures permitted 1
pursuant to this chapter by a health care practitioner who is 2
physically present and is immediately available in the facility, 3
except as provided in (b) and (c) of this subsection.4
(b) The health care practitioner does not need to be present 5
during procedures to withdraw blood, administer vaccines, or obtain 6
specimens for or perform diagnostic testing, but must be immediately 7
available. 8
(c)(i) During a telemedicine visit, supervision over a medical 9
assistant assisting a health care practitioner with the telemedicine 10
visit may be provided through interactive audio and video 11
telemedicine technology. 12
(ii) When administering intramuscular injections for the purposes 13
of treating a known or suspected syphilis infection in accordance 14
with RCW 18.360.050, a medical assistant-certified or medical 15
assistant-registered may be supervised through interactive audio or 16
video telemedicine technology. 17
Sec. 52. RCW 28A.210.090 and 2025 c 58 s 5086 are each amended 18
to read as follows: 19
(1) Any child shall be exempt in whole or in part from the 20
immunization measures required by RCW 28A.210.060 through 28A.210.170 21
upon the presentation of any one or more of the certifications 22
required by this section, on a form prescribed by the department of 23
health: 24
(a) A written certification signed by a health care practitioner 25
that a particular vaccine required by rule of the state board of 26
health is, in his or her judgment, not advisable for the child: 27
PROVIDED, That when it is determined that this particular vaccine is 28
no longer contraindicated, the child will be required to have the 29
vaccine; 30
(b) A written certification signed by any parent or legal 31
guardian of the child or any adult in loco parentis to the child that 32
the religious beliefs of the signator are contrary to the required 33
immunization measures; or 34
(c) A written certification signed by any parent or legal 35
guardian of the child or any adult in loco parentis to the child that 36
the signator has either a philosophical or personal objection to the 37
immunization of the child. A philosophical or personal objection may 38
p. 70 HB 2127
not be used to exempt a child from the measles, mumps, and rubella 1
vaccine. 2
(2)(a) The form presented on or after July 22, 2011, must include 3
a statement to be signed by a health care practitioner stating that 4
he or she provided the signator with information about the benefits 5
and risks of immunization to the child. The form may be signed by a 6
health care practitioner at any time prior to the enrollment of the 7
child in a school or licensed day care. Photocopies of the signed 8
form or a letter from the health care practitioner referencing the 9
child's name shall be accepted in lieu of the original form.10
(b) A health care practitioner who, in good faith, signs the 11
statement provided for in (a) of this subsection is immune from civil 12
liability for providing the signature. 13
(c) Any parent or legal guardian of the child or any adult in 14
loco parentis to the child who exempts the child due to religious 15
beliefs pursuant to subsection (1)(b) of this section is not required 16
to have the form provided for in (a) of this subsection signed by a 17
health care practitioner if the parent or legal guardian demonstrates 18
membership in a religious body or a church in which the religious 19
beliefs or teachings of the church preclude a health care 20
practitioner from providing medical treatment to the child.21
(3) For purposes of this section, "health care practitioner" 22
means a physician licensed under chapter 18.71 or 18.57 RCW, a 23
naturopath licensed under chapter 18.36A RCW, a physician 24
((assistant)) associate licensed under chapter 18.71A RCW, or an 25
advanced practice registered nurse licensed under chapter 18.79 RCW.26
Sec. 53. RCW 41.05.177 and 2025 c 58 s 5091 are each amended to 27
read as follows: 28
(1) Each plan offered to public employees and their covered 29
dependents under this chapter that is not subject to the provisions 30
of Title 48 RCW and is issued or renewed after December 31, 2006, 31
shall provide coverage for prostate cancer screening, provided that 32
the screening is delivered upon the recommendation of the patient's 33
physician, advanced practice registered nurse, or physician 34
((assistant)) associate. 35
(2) This section shall not be construed to prevent the 36
application of standard policy provisions applicable to other 37
benefits, such as deductible or copayment provisions. This section 38
does not limit the authority of the health care authority to 39
p. 71 HB 2127
negotiate rates and contract with specific providers for the delivery 1
of prostate cancer screening services. This section shall not apply 2
to medicare supplemental policies or supplemental contracts covering 3
a specified disease or other limited benefits. 4
Sec. 54. RCW 41.05.180 and 2025 c 58 s 5092 are each amended to 5
read as follows: 6
Each health plan offered to public employees and their covered 7
dependents under this chapter that is not subject to the provisions 8
of Title 48 RCW and is established or renewed after January 1, 1990, 9
and that provides benefits for hospital or medical care shall provide 10
benefits for screening or diagnostic mammography services, provided 11
that such services are delivered upon the recommendation of the 12
patient's physician or advanced practice registered nurse as 13
authorized by the state board of nursing pursuant to chapter 18.79 14
RCW or physician ((assistant)) associate pursuant to chapter 18.71A 15
RCW. 16
This section shall not be construed to prevent the application of 17
standard health plan provisions applicable to other benefits such as 18
deductible or copayment provisions. This section does not limit the 19
authority of the state health care authority to negotiate rates and 20
contract with specific providers for the delivery of mammography 21
services. This section shall not apply to medicare supplement 22
policies or supplemental contracts covering a specified disease or 23
other limited benefits. 24
Sec. 55. RCW 43.70.110 and 2025 c 19 s 1 are each amended to 25
read as follows: 26
(1) The secretary shall charge fees to the licensee for obtaining 27
a license. Physicians regulated pursuant to chapter 18.71 RCW who 28
reside and practice in Washington and obtain or renew a retired 29
active license are exempt from such fees. Municipal corporations 30
providing emergency medical care and transportation services pursuant 31
to chapter 18.73 RCW shall be exempt from such fees, provided that 32
such other emergency services shall only be charged for their pro 33
rata share of the cost of licensure and inspection, if appropriate. 34
The secretary may charge different fees for registered nurses 35
licensed under chapter 18.79 RCW, licensed practical nurses licensed 36
under chapter 18.79 RCW, and nurses who hold a valid multistate 37
license issued by the state of Washington under chapter 18.80 RCW. 38
p. 72 HB 2127
The secretary may waive the fees when, in the discretion of the 1
secretary, the fees would not be in the best interest of public 2
health and safety, or when the fees would be to the financial 3
disadvantage of the state. 4
(2) Except as provided in subsection (3) of this section, fees 5
charged shall be based on, but shall not exceed, the cost to the 6
department for the licensure of the activity or class of activities 7
and may include costs of necessary inspection. 8
(3) License fees shall include amounts in addition to the cost of 9
licensure activities in the following circumstances:10
(a) For registered nurses and licensed practical nurses licensed 11
under chapter 18.79 RCW, and for nurses who hold a valid multistate 12
license issued by the state of Washington under chapter 18.80 RCW, 13
support of a central nursing resource center as provided in RCW 14
18.79.202; 15
(b) For all health care providers licensed under RCW 18.130.040, 16
the cost of regulatory activities for retired volunteer medical 17
worker licensees as provided in RCW 18.130.360; and18
(c) For physicians licensed under chapter 18.71 RCW, physician 19
((assistants)) associates licensed under chapter 18.71A RCW, 20
osteopathic physicians licensed under chapter 18.57 RCW, naturopaths 21
licensed under chapter 18.36A RCW, podiatrists licensed under chapter 22
18.22 RCW, chiropractors licensed under chapter 18.25 RCW, 23
psychologists and psychological associates licensed under chapter 24
18.83 RCW, registered nurses and licensed practical nurses licensed 25
under chapter 18.79 RCW, nurses who hold a valid multistate license 26
issued by the state of Washington under chapter 18.80 RCW, 27
optometrists licensed under chapter 18.53 RCW, mental health 28
counselors and mental health counselor associates licensed under 29
chapter 18.225 RCW, massage therapists licensed under chapter 18.108 30
RCW, advanced social workers licensed under chapter 18.225 RCW, 31
independent clinical social workers and independent clinical social 32
worker associates licensed under chapter 18.225 RCW, midwives 33
licensed under chapter 18.50 RCW, marriage and family therapists and 34
marriage and family therapist associates licensed under chapter 35
18.225 RCW, occupational therapists and occupational therapy 36
assistants licensed under chapter 18.59 RCW, dietitians and 37
nutritionists certified under chapter 18.138 RCW, speech-language 38
pathologists licensed under chapter 18.35 RCW, acupuncturists or 39
acupuncture and Eastern medicine practitioners licensed under chapter 40
p. 73 HB 2127
18.06 RCW, and veterinarians and veterinary technicians licensed 1
under chapter 18.92 RCW, the license fees shall include up to an 2
additional twenty-five dollars to be transferred by the department to 3
the University of Washington for the purposes of RCW 43.70.112.4
(4) Department of health advisory committees may review fees 5
established by the secretary for licenses and comment upon the 6
appropriateness of the level of such fees. 7
Sec. 56. RCW 43.70.442 and 2025 c 58 s 5094 are each amended to 8
read as follows: 9
(1)(a) Each of the following professionals certified or licensed 10
under Title 18 RCW shall, at least once every six years, complete 11
training in suicide assessment, treatment, and management that is 12
approved, in rule, by the relevant disciplining authority:13
(i) An adviser or counselor certified under chapter 18.19 RCW;14
(ii) A substance use disorder professional licensed under chapter 15
18.205 RCW; 16
(iii) A marriage and family therapist licensed under chapter 17
18.225 RCW; 18
(iv) A mental health counselor licensed under chapter 18.225 RCW;19
(v) An occupational therapy practitioner licensed under chapter 20
18.59 RCW; 21
(vi) A psychologist licensed under chapter 18.83 RCW;22
(vii) An advanced social worker or independent clinical social 23
worker licensed under chapter 18.225 RCW; and 24
(viii) A social worker associate —advanced or social worker 25
associate—independent clinical licensed under chapter 18.225 RCW.26
(b) The requirements in (a) of this subsection apply to a person 27
holding a retired active license for one of the professions in (a) of 28
this subsection. 29
(c) The training required by this subsection must be at least six 30
hours in length, unless a disciplining authority has determined, 31
under subsection (10)(b) of this section, that training that includes 32
only screening and referral elements is appropriate for the 33
profession in question, in which case the training must be at least 34
three hours in length. 35
(d) Beginning July 1, 2017, the training required by this 36
subsection must be on the model list developed under subsection (6) 37
of this section. Nothing in this subsection (1)(d) affects the 38
validity of training completed prior to July 1, 2017.39
p. 74 HB 2127
(2)(a) Except as provided in (b) of this subsection:1
(i) A professional listed in subsection (1)(a) of this section 2
must complete the first training required by this section by the end 3
of the first full continuing education reporting period after January 4
1, 2014, or during the first full continuing education reporting 5
period after initial licensure or certification, whichever occurs 6
later. 7
(ii) Beginning July 1, 2021, the second training for a 8
psychologist, a marriage and family therapist, a mental health 9
counselor, an advanced social worker, an independent clinical social 10
worker, a social worker associate-advanced, or a social worker 11
associate-independent clinical must be either: (A) An advanced 12
training focused on suicide management, suicide care protocols, or 13
effective treatments; or (B) a training in a treatment modality shown 14
to be effective in working with people who are suicidal, including 15
dialectical behavior therapy, collaborative assessment and management 16
of suicide risk, or cognitive behavior therapy-suicide prevention. If 17
a professional subject to the requirements of this subsection has 18
already completed the professional's second training prior to July 1, 19
2021, the professional's next training must comply with this 20
subsection. This subsection (2)(a)(ii) does not apply if the licensee 21
demonstrates that the training required by this subsection (2)(a)(ii) 22
is not reasonably available. 23
(b)(i) A professional listed in subsection (1)(a) of this section 24
applying for initial licensure may delay completion of the first 25
training required by this section for six years after initial 26
licensure if he or she can demonstrate successful completion of the 27
training required in subsection (1) of this section no more than six 28
years prior to the application for initial licensure.29
(ii) Beginning July 1, 2021, a psychologist, a marriage and 30
family therapist, a mental health counselor, an advanced social 31
worker, an independent clinical social worker, a social worker 32
associate-advanced, or a social worker associate-independent clinical 33
exempt from his or her first training under (b)(i) of this subsection 34
must comply with the requirements of (a)(ii) of this subsection for 35
his or her first training after initial licensure. If a professional 36
subject to the requirements of this subsection has already completed 37
the professional's first training after initial licensure, the 38
professional's next training must comply with this subsection 39
(2)(b)(ii). This subsection (2)(b)(ii) does not apply if the licensee 40
p. 75 HB 2127
demonstrates that the training required by this subsection (2)(b)(ii) 1
is not reasonably available. 2
(3) The hours spent completing training in suicide assessment, 3
treatment, and management under this section count toward meeting any 4
applicable continuing education or continuing competency requirements 5
for each profession. 6
(4)(a) A disciplining authority may, by rule, specify minimum 7
training and experience that is sufficient to exempt an individual 8
professional from the training requirements in subsections (1) and 9
(5) of this section. Nothing in this subsection (4)(a) allows a 10
disciplining authority to provide blanket exemptions to broad 11
categories or specialties within a profession. 12
(b) A disciplining authority may exempt a professional from the 13
training requirements of subsections (1) and (5) of this section if 14
the professional has only brief or limited patient contact.15
(5)(a) Each of the following professionals credentialed under 16
Title 18 RCW shall complete a one-time training in suicide 17
assessment, treatment, and management that is approved by the 18
relevant disciplining authority: 19
(i) A chiropractor licensed under chapter 18.25 RCW;20
(ii) A naturopath licensed under chapter 18.36A RCW;21
(iii) A licensed practical nurse, registered nurse, or advanced 22
practice registered nurse, other than a certified registered nurse 23
anesthetist, licensed under chapter 18.79 RCW; 24
(iv) An osteopathic physician and surgeon licensed under chapter 25
18.57 RCW, other than a holder of a postgraduate osteopathic medicine 26
and surgery license issued under RCW 18.57.035; 27
(v) A physical therapist or physical therapist assistant licensed 28
under chapter 18.74 RCW; 29
(vi) A physician licensed under chapter 18.71 RCW, other than a 30
resident holding a limited license issued under RCW 18.71.095(3);31
(vii) A physician ((assistant)) associate licensed under chapter 32
18.71A RCW; 33
(viii) A pharmacist licensed under chapter 18.64 RCW;34
(ix) A dentist licensed under chapter 18.32 RCW;35
(x) A dental hygienist licensed under chapter 18.29 RCW;36
(xi) An athletic trainer licensed under chapter 18.250 RCW;37
(xii) An optometrist licensed under chapter 18.53 RCW;38
(xiii) An acupuncture and Eastern medicine practitioner licensed 39
under chapter 18.06 RCW; 40
p. 76 HB 2127
(xiv) A dental therapist licensed under chapter 18.265 RCW; and1
(xv) A person holding a retired active license for one of the 2
professions listed in (a)(i) through (xiv) of this subsection.3
(b)(i) A professional listed in (a)(i) through (vii) of this 4
subsection or a person holding a retired active license for one of 5
the professions listed in (a)(i) through (vii) of this subsection 6
must complete the one-time training by the end of the first full 7
continuing education reporting period after January 1, 2016, or 8
during the first full continuing education reporting period after 9
initial licensure, whichever is later. Training completed between 10
June 12, 2014, and January 1, 2016, that meets the requirements of 11
this section, other than the timing requirements of this subsection 12
(5)(b), must be accepted by the disciplining authority as meeting the 13
one-time training requirement of this subsection (5).14
(ii) A licensed pharmacist or a person holding a retired active 15
pharmacist license must complete the one-time training by the end of 16
the first full continuing education reporting period after January 1, 17
2017, or during the first full continuing education reporting period 18
after initial licensure, whichever is later. 19
(iii) A licensed dentist, a licensed dental hygienist, or a 20
person holding a retired active license as a dentist shall complete 21
the one-time training by the end of the full continuing education 22
reporting period after August 1, 2020, or during the first full 23
continuing education reporting period after initial licensure, 24
whichever is later. Training completed between July 23, 2017, and 25
August 1, 2020, that meets the requirements of this section, other 26
than the timing requirements of this subsection (5)(b)(iii), must be 27
accepted by the disciplining authority as meeting the one-time 28
training requirement of this subsection (5). 29
(iv) A licensed optometrist or a licensed acupuncture and Eastern 30
medicine practitioner, or a person holding a retired active license 31
as an optometrist or an acupuncture and Eastern medicine 32
practitioner, shall complete the one-time training by the end of the 33
full continuing education reporting period after August 1, 2021, or 34
during the first full continuing education reporting period after 35
initial licensure, whichever is later. Training completed between 36
August 1, 2020, and August 1, 2021, that meets the requirements of 37
this section, other than the timing requirements of this subsection 38
(5)(b)(iv), must be accepted by the disciplining authority as meeting 39
the one-time training requirement of this subsection (5).40
p. 77 HB 2127
(c) The training required by this subsection must be at least six 1
hours in length, unless a disciplining authority has determined, 2
under subsection (10)(b) of this section, that training that includes 3
only screening and referral elements is appropriate for the 4
profession in question, in which case the training must be at least 5
three hours in length. 6
(d) Beginning July 1, 2017, the training required by this 7
subsection must be on the model list developed under subsection (6) 8
of this section. Nothing in this subsection (5)(d) affects the 9
validity of training completed prior to July 1, 2017.10
(6)(a) The secretary and the disciplining authorities shall work 11
collaboratively to develop a model list of training programs in 12
suicide assessment, treatment, and management. Beginning July 1, 13
2021, for purposes of subsection (2)(a)(ii) of this section, the 14
model list must include advanced training and training in treatment 15
modalities shown to be effective in working with people who are 16
suicidal. 17
(b) The secretary and the disciplining authorities shall update 18
the list at least once every two years. 19
(c) By June 30, 2016, the department shall adopt rules 20
establishing minimum standards for the training programs included on 21
the model list. The minimum standards must require that six-hour 22
trainings include content specific to veterans and the assessment of 23
issues related to imminent harm via lethal means or self-injurious 24
behaviors and that three-hour trainings for pharmacists or dentists 25
include content related to the assessment of issues related to 26
imminent harm via lethal means. By July 1, 2024, the minimum 27
standards must be updated to require that both the six-hour and 28
three-hour trainings include content specific to the availability of 29
and the services offered by the 988 crisis hotline and the behavioral 30
health crisis response and suicide prevention system and best 31
practices for assisting persons with accessing the 988 crisis hotline 32
and the system. Beginning September 1, 2024, trainings submitted to 33
the department for review and approval must include the updated 34
information in the minimum standards for the model list as well as 35
all subsequent submissions. When adopting the rules required under 36
this subsection (6)(c), the department shall: 37
(i) Consult with the affected disciplining authorities, public 38
and private institutions of higher education, educators, experts in 39
suicide assessment, treatment, and management, the Washington 40
p. 78 HB 2127
department of veterans affairs, and affected professional 1
associations; and 2
(ii) Consider standards related to the best practices registry of 3
the American foundation for suicide prevention and the suicide 4
prevention resource center. 5
(d) Beginning January 1, 2017: 6
(i) The model list must include only trainings that meet the 7
minimum standards established in the rules adopted under (c) of this 8
subsection and any three-hour trainings that met the requirements of 9
this section on or before July 24, 2015; 10
(ii) The model list must include six-hour trainings in suicide 11
assessment, treatment, and management, and three-hour trainings that 12
include only screening and referral elements; and 13
(iii) A person or entity providing the training required in this 14
section may petition the department for inclusion on the model list. 15
The department shall add the training to the list only if the 16
department determines that the training meets the minimum standards 17
established in the rules adopted under (c) of this subsection.18
(e) By January 1, 2021, the department shall adopt minimum 19
standards for advanced training and training in treatment modalities 20
shown to be effective in working with people who are suicidal. 21
Beginning July 1, 2021, all such training on the model list must meet 22
the minimum standards. When adopting the minimum standards, the 23
department must consult with the affected disciplining authorities, 24
public and private institutions of higher education, educators, 25
experts in suicide assessment, treatment, and management, the 26
Washington department of veterans affairs, and affected professional 27
associations. 28
(7) The department shall provide the health profession training 29
standards created in this section to the professional educator 30
standards board as a model in meeting the requirements of RCW 31
28A.410.226 and provide technical assistance, as requested, in the 32
review and evaluation of educator training programs. The educator 33
training programs approved by the professional educator standards 34
board may be included in the department's model list.35
(8) Nothing in this section may be interpreted to expand or limit 36
the scope of practice of any profession regulated under chapter 37
18.130 RCW. 38
p. 79 HB 2127
(9) The secretary and the disciplining authorities affected by 1
this section shall adopt any rules necessary to implement this 2
section. 3
(10) For purposes of this section: 4
(a) "Disciplining authority" has the same meaning as in RCW 5
18.130.020. 6
(b) "Training in suicide assessment, treatment, and management" 7
means empirically supported training approved by the appropriate 8
disciplining authority that contains the following elements: Suicide 9
assessment, including screening and referral, suicide treatment, and 10
suicide management. However, the disciplining authority may approve 11
training that includes only screening and referral elements if 12
appropriate for the profession in question based on the profession's 13
scope of practice. The board of occupational therapy may also approve 14
training that includes only screening and referral elements if 15
appropriate for occupational therapy practitioners based on practice 16
setting. 17
(11) A state or local government employee is exempt from the 18
requirements of this section if he or she receives a total of at 19
least six hours of training in suicide assessment, treatment, and 20
management from his or her employer every six years. For purposes of 21
this subsection, the training may be provided in one six -hour block 22
or may be spread among shorter training sessions at the employer's 23
discretion. 24
(12) An employee of a community mental health agency licensed 25
under chapter 71.24 RCW or a chemical dependency program certified 26
under chapter 71.24 RCW is exempt from the requirements of this 27
section if he or she receives a total of at least six hours of 28
training in suicide assessment, treatment, and management from his or 29
her employer every six years. For purposes of this subsection, the 30
training may be provided in one six-hour block or may be spread among 31
shorter training sessions at the employer's discretion.32
Sec. 57. RCW 43.70.470 and 2025 c 58 s 5095 are each amended to 33
read as follows: 34
The department may establish by rule the conditions of 35
participation in the liability insurance program by retired health 36
care providers at clinics utilizing retired health care providers for 37
the purposes of this section and RCW 43.70.460. These conditions 38
shall include, but not be limited to, the following:39
p. 80 HB 2127
(1) The participating health care provider associated with the 1
clinic shall hold a valid license to practice as a physician under 2
chapter 18.71 or 18.57 RCW, a naturopath under chapter 18.36A RCW, a 3
physician ((assistant)) associate under chapter 18.71A RCW, an 4
advanced practice registered nurse under chapter 18.79 RCW, a dentist 5
under chapter 18.32 RCW, or other health professionals as may be 6
deemed in short supply by the department. All health care providers 7
must be in conformity with current requirements for licensure, 8
including continuing education requirements; 9
(2) Health care shall be limited to noninvasive procedures and 10
shall not include obstetrical care. Noninvasive procedures include 11
injections, suturing of minor lacerations, and incisions of boils or 12
superficial abscesses. Primary dental care shall be limited to 13
diagnosis, oral hygiene, restoration, and extractions and shall not 14
include orthodontia, or other specialized care and treatment;15
(3) The provision of liability insurance coverage shall not 16
extend to acts outside the scope of rendering health care services 17
pursuant to this section and RCW 43.70.460; 18
(4) The participating health care provider shall limit the 19
provision of health care services to primarily low-income persons 20
provided that clinics may, but are not required to, provide means 21
tests for eligibility as a condition for obtaining health care 22
services; 23
(5) The participating health care provider shall not accept 24
compensation for providing health care services from patients served 25
pursuant to this section and RCW 43.70.460, nor from clinics serving 26
these patients. "Compensation" shall mean any remuneration of value 27
to the participating health care provider for services provided by 28
the health care provider, but shall not be construed to include any 29
nominal copayments charged by the clinic, nor reimbursement of 30
related expenses of a participating health care provider authorized 31
by the clinic in advance of being incurred; and 32
(6) The use of mediation or arbitration for resolving questions 33
of potential liability may be used, however any mediation or 34
arbitration agreement format shall be expressed in terms clear enough 35
for a person with a sixth grade level of education to understand, and 36
on a form no longer than one page in length. 37
Sec. 58. RCW 46.19.010 and 2025 c 295 s 1 and 2025 c 58 s 5096 38
are each reenacted and amended to read as follows:39
p. 81 HB 2127
(1) A natural person who has a disability that meets one of the 1
following criteria may apply for special parking privileges:2
(a) Cannot walk 200 feet without stopping to rest;3
(b) Is severely limited in ability to walk due to arthritic, 4
neurological, or orthopedic condition; 5
(c) Has such a severe disability that the person cannot walk 6
without the use of or assistance from a brace, cane, another person, 7
prosthetic device, wheelchair, or other assistive device;8
(d) Uses portable oxygen; 9
(e) Is restricted by lung disease to an extent that forced 10
expiratory respiratory volume, when measured by spirometry, is less 11
than one liter per second or the arterial oxygen tension is less than 12
60 mm/hg on room air at rest; 13
(f) Impairment by cardiovascular disease or cardiac condition to 14
the extent that the person's functional limitations are classified as 15
class III or IV under standards accepted by the American heart 16
association; 17
(g) Has a disability resulting from an acute sensitivity to 18
automobile emissions that limits or impairs the ability to walk. The 19
personal physician, advanced practice registered nurse, or physician 20
((assistant)) associate of the applicant shall document that the 21
disability is comparable in severity to the others listed in this 22
subsection; 23
(h) Has limited mobility and has no vision or whose vision with 24
corrective lenses is so limited that the person requires alternative 25
methods or skills to do efficiently those things that are ordinarily 26
done with sight by persons with normal vision; 27
(i) Has an eye condition of a progressive nature that may lead to 28
blindness; 29
(j) Is restricted by a form of porphyria to the extent that the 30
applicant would significantly benefit from a decrease in exposure to 31
light; or 32
(k) Is a veteran, as defined in RCW 41.04.007, who has a 70 33
percent or higher disability rating from the United States armed 34
forces or United States department of veterans affairs and uses a 35
service animal as defined in 28 C.F.R. 35.104. 36
(2) The disability in subsection (1)(a) through (j) of this 37
section must be determined by either: 38
(a) A licensed physician; 39
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(b) An advanced practice registered nurse licensed under chapter 1
18.79 RCW; or 2
(c) A physician ((assistant)) associate licensed under chapter 3
18.71A RCW. 4
(3) A health care practitioner listed under subsection (2) of 5
this section who is authorizing a parking permit for purposes of this 6
chapter must provide a signed written authorization: On a 7
prescription pad or paper, as defined in RCW 18.64.500; on office 8
letterhead; or by electronic means, as described by the director in 9
rule. 10
Sec. 59. RCW 46.19.010 and 2020 c 80 s 32 are each amended to 11
read as follows: 12
(1) A natural person who has a disability that meets one of the 13
following criteria may apply for special parking privileges:14
(a) Cannot walk ((two hundred )) 200 feet without stopping to 15
rest; 16
(b) Is severely limited in ability to walk due to arthritic, 17
neurological, or orthopedic condition; 18
(c) Has such a severe disability that the person cannot walk 19
without the use of or assistance from a brace, cane, another person, 20
prosthetic device, wheelchair, or other assistive device;21
(d) Uses portable oxygen; 22
(e) Is restricted by lung disease to an extent that forced 23
expiratory respiratory volume, when measured by spirometry, is less 24
than one liter per second or the arterial oxygen tension is less than 25
((sixty)) 60 mm/hg on room air at rest; 26
(f) Impairment by cardiovascular disease or cardiac condition to 27
the extent that the person's functional limitations are classified as 28
class III or IV under standards accepted by the American heart 29
association; 30
(g) Has a disability resulting from an acute sensitivity to 31
automobile emissions that limits or impairs the ability to walk. The 32
personal physician, advanced practice registered nurse 33
((practitioner)), or physician ((assistant)) associate of the 34
applicant shall document that the disability is comparable in 35
severity to the others listed in this subsection; 36
(h) Has limited mobility and has no vision or whose vision with 37
corrective lenses is so limited that the person requires alternative 38
p. 83 HB 2127
methods or skills to do efficiently those things that are ordinarily 1
done with sight by persons with normal vision; 2
(i) Has an eye condition of a progressive nature that may lead to 3
blindness; or 4
(j) Is restricted by a form of porphyria to the extent that the 5
applicant would significantly benefit from a decrease in exposure to 6
light. 7
(2) The disability must be determined by either:8
(a) A licensed physician; 9
(b) An advanced practice registered nurse ((practitioner)) 10
licensed under chapter 18.79 RCW; or 11
(c) A physician ((assistant)) associate licensed under chapter 12
18.71A RCW. 13
(3) A health care practitioner listed under subsection (2) of 14
this section who is authorizing a parking permit for purposes of this 15
chapter must provide a signed written authorization: On a 16
prescription pad or paper, as defined in RCW 18.64.500; on office 17
letterhead; or by electronic means, as described by the director in 18
rule. 19
(4) The application for special parking privileges for persons 20
with disabilities must contain: 21
(a) The following statement immediately below the physician's, 22
advanced practice registered nurse's ((practitioner's)), or physician 23
((assistant's)) associate's signature: "A parking permit for a person 24
with disabilities may be issued only for a medical necessity that 25
severely affects mobility or involves acute sensitivity to light (RCW 26
46.19.010). An applicant or health care practitioner who knowingly 27
provides false information on this application is guilty of a gross 28
misdemeanor. The penalty is up to ((three hundred sixty-four )) 364 29
days in jail and a fine of up to $5,000 or both. In addition, the 30
health care practitioner may be subject to sanctions under chapter 31
18.130 RCW, the Uniform Disciplinary Act"; and 32
(b) Other information as required by the department.33
(5) A natural person who has a disability described in subsection 34
(1) of this section and is expected to improve within ((twelve)) 12 35
months may be issued a temporary placard for a period not to exceed 36
((twelve)) 12 months. If the disability exists after ((twelve)) 12 37
months, a new temporary placard must be issued upon receipt of a new 38
application with certification from the person's physician as 39
prescribed in subsections (3) and (4) of this section. Special 40
p. 84 HB 2127
license plates for persons with disabilities may not be issued to a 1
person with a temporary disability. 2
(6) A natural person who qualifies for special parking privileges 3
under this section must receive an identification card showing the 4
name and date of birth of the person to whom the parking privilege 5
has been issued and the serial number of the placard.6
(7) A natural person who qualifies for permanent special parking 7
privileges under this section may receive one of the following:8
(a) Up to two parking placards; 9
(b) One set of special license plates for persons with 10
disabilities if the person with the disability is the registered 11
owner of the vehicle on which the license plates will be displayed;12
(c) One parking placard and one set of special license plates for 13
persons with disabilities if the person with the disability is the 14
registered owner of the vehicle on which the license plates will be 15
displayed; or 16
(d) One special parking year tab for persons with disabilities 17
and one parking placard. 18
(8) Parking placards and identification cards described in this 19
section must be issued free of charge. 20
(9) The parking placard and identification card must be 21
immediately returned to the department upon the placard holder's 22
death. 23
Sec. 60. RCW 46.19.080 and 2025 c 295 s 2 are each amended to 24
read as follows: 25
(1) The application for special parking privileges for persons 26
with disabilities must contain: 27
(a) The following statement immediately below the physician's, 28
advanced practice registered nurse's ((practitioner's)), or physician 29
((assistant's)) associate's signature: "A parking permit for a person 30
with disabilities may be issued only for a medical necessity that 31
severely affects mobility or involves acute sensitivity to light (RCW 32
46.19.010). An applicant or health care practitioner who knowingly 33
provides false information on this application is guilty of a gross 34
misdemeanor. The penalty is up to 364 days in jail and a fine of up 35
to $5,000 or both. In addition, the health care practitioner may be 36
subject to sanctions under chapter 18.130 RCW, the Uniform 37
Disciplinary Act"; and 38
(b) Other information as required by the department.39
p. 85 HB 2127
(2) A natural person who has a disability described in RCW 1
46.19.010(1) and is expected to improve within 12 months may be 2
issued a temporary placard for a period not to exceed 12 months. If 3
the disability exists after 12 months, a new temporary placard must 4
be issued upon receipt of a new application with certification from 5
the person's physician as prescribed in RCW 46.19.010(3) and 6
subsection (1) of this section. Special license plates for persons 7
with disabilities may not be issued to a person with a temporary 8
disability. 9
(3) A natural person or veteran who qualifies for special parking 10
privileges under this section must receive an identification card 11
showing the name and date of birth of the person to whom the parking 12
privilege has been issued and the serial number of the placard.13
(4) A natural person or veteran who qualifies for permanent 14
special parking privileges under RCW 46.19.010 may receive one of the 15
following: 16
(a) Up to two parking placards; 17
(b) One set of special license plates for persons with 18
disabilities if the person with the disability is the registered 19
owner of the vehicle on which the license plates will be displayed;20
(c) One parking placard and one set of special license plates for 21
persons with disabilities if the person with the disability is the 22
registered owner of the vehicle on which the license plates will be 23
displayed; or 24
(d) One special parking year tab for persons with disabilities 25
and one parking placard. 26
(5) Parking placards and identification cards described in this 27
section must be issued free of charge. 28
(6) The parking placard and identification card must be 29
immediately returned to the department upon the placard holder's 30
death. 31
(7) This section expires October 1, 2035. 32
Sec. 61. RCW 46.61.506 and 2025 c 58 s 5097 are each amended to 33
read as follows: 34
(1) Upon the trial of any civil or criminal action or proceeding 35
arising out of acts alleged to have been committed by any person 36
while driving or in actual physical control of a vehicle while under 37
the influence of intoxicating liquor or any drug, if the person's 38
alcohol concentration is less than 0.08 or the person's THC 39
p. 86 HB 2127
concentration is less than 5.00, it is evidence that may be 1
considered with other competent evidence in determining whether the 2
person was under the influence of intoxicating liquor or any drug.3
(2)(a) The breath analysis of the person's alcohol concentration 4
shall be based upon grams of alcohol per two hundred ten liters of 5
breath. 6
(b) The blood analysis of the person's THC concentration shall be 7
based upon nanograms per milliliter of whole blood.8
(c) The foregoing provisions of this section shall not be 9
construed as limiting the introduction of any other competent 10
evidence bearing upon the question whether the person was under the 11
influence of intoxicating liquor or any drug. 12
(3) Analysis of the person's blood or breath to be considered 13
valid under the provisions of this section or RCW 46.61.502 or 14
46.61.504 shall have been performed according to methods approved by 15
the state toxicologist and by an individual possessing a valid permit 16
issued by the state toxicologist for this purpose. The state 17
toxicologist is directed to approve satisfactory techniques or 18
methods, to supervise the examination of individuals to ascertain 19
their qualifications and competence to conduct such analyses, and to 20
issue permits which shall be subject to termination or revocation at 21
the discretion of the state toxicologist. 22
(4)(a) A breath test performed by any instrument approved by the 23
state toxicologist shall be admissible at trial or in an 24
administrative proceeding if the prosecution or department produces 25
prima facie evidence of the following: 26
(i) The person who performed the test was authorized to perform 27
such test by the state toxicologist; 28
(ii) The person being tested did not vomit or have anything to 29
eat, drink, or smoke for at least fifteen minutes prior to 30
administration of the test; 31
(iii) The person being tested did not have any foreign 32
substances, not to include dental work or piercings, fixed or 33
removable, in his or her mouth at the beginning of the fifteen-minute 34
observation period; 35
(iv) Prior to the start of the test, the temperature of any 36
liquid simulator solution utilized as an external standard, as 37
measured by a thermometer approved of by the state toxicologist was 38
thirty-four degrees centigrade plus or minus 0.3 degrees centigrade;39
p. 87 HB 2127
(v) The internal standard test resulted in the message 1
"verified"; 2
(vi) The two breath samples agree to within plus or minus ten 3
percent of their mean to be determined by the method approved by the 4
state toxicologist; 5
(vii) The result of the test of the liquid simulator solution 6
external standard or dry gas external standard result did lie 7
between .072 to .088 inclusive; and 8
(viii) All blank tests gave results of .000. 9
(b) For purposes of this section, "prima facie evidence" is 10
evidence of sufficient circumstances that would support a logical and 11
reasonable inference of the facts sought to be proved. In assessing 12
whether there is sufficient evidence of the foundational facts, the 13
court or administrative tribunal is to assume the truth of the 14
prosecution's or department's evidence and all reasonable inferences 15
from it in a light most favorable to the prosecution or department.16
(c) Nothing in this section shall be deemed to prevent the 17
subject of the test from challenging the reliability or accuracy of 18
the test, the reliability or functioning of the instrument, or any 19
maintenance procedures. Such challenges, however, shall not preclude 20
the admissibility of the test once the prosecution or department has 21
made a prima facie showing of the requirements contained in (a) of 22
this subsection. Instead, such challenges may be considered by the 23
trier of fact in determining what weight to give to the test result.24
(5) When a blood test is administered under the provisions of RCW 25
46.20.308, the withdrawal of blood for the purpose of determining its 26
alcohol or drug content may be performed only by a physician licensed 27
under chapter 18.71 RCW; an osteopathic physician licensed under 28
chapter 18.57 RCW; a registered nurse, licensed practical nurse, or 29
advanced practice registered nurse licensed under chapter 18.79 RCW; 30
a physician ((assistant)) associate licensed under chapter 18.71A 31
RCW; an advanced emergency medical technician or paramedic certified 32
under chapter 18.71 RCW; or a medical assistant-certified or medical 33
assistant-phlebotomist certified under chapter 18.360 RCW, a person 34
holding another credential under Title 18 RCW whose scope of practice 35
includes performing venous blood draws, or a forensic phlebotomist 36
certified under chapter 18.360 RCW. When the blood test is performed 37
outside the state of Washington, the withdrawal of blood for the 38
purpose of determining its alcohol or drug content may be performed 39
by any person who is authorized by the out-of-state jurisdiction to 40
p. 88 HB 2127
perform venous blood draws. Proof of qualification to draw blood may 1
be established through the department of health's provider credential 2
search. This limitation shall not apply to the taking of breath 3
specimens. 4
(6) When a venous blood sample is performed by a forensic 5
phlebotomist certified under chapter 18.360 RCW, it must be done 6
under the following conditions: 7
(a) If taken at the scene, it must be performed in an ambulance 8
or aid service vehicle licensed by the department of health under 9
chapter 18.73 RCW. 10
(b) The collection of blood samples must not interfere with the 11
provision of essential medical care. 12
(c) The blood sample must be collected using sterile equipment 13
and the skin area of puncture must be thoroughly cleansed and 14
disinfected. 15
(d) The person whose blood is collected must be seated, reclined, 16
or lying down when the blood is collected. 17
(7) The person tested may have a licensed or certified health 18
care provider listed in subsection (5) of this section, or a 19
qualified technician, chemist, or other qualified person of his or 20
her own choosing administer one or more tests in addition to any 21
administered at the direction of a law enforcement officer. The test 22
will be admissible if the person establishes the general 23
acceptability of the testing technique or method. The failure or 24
inability to obtain an additional test by a person shall not preclude 25
the admission of evidence relating to the test or tests taken at the 26
direction of a law enforcement officer. 27
(8) Upon the request of the person who shall submit to a test or 28
tests at the request of a law enforcement officer, full information 29
concerning the test or tests shall be made available to him or her or 30
his or her attorney. 31
Sec. 62. RCW 46.61.508 and 2025 c 58 s 5098 are each amended to 32
read as follows: 33
No physician licensed under chapter 18.71 RCW; osteopathic 34
physician licensed under chapter 18.57 RCW; registered nurse, 35
licensed practical nurse, or advanced practice registered nurse 36
licensed under chapter 18.79 RCW; physician ((assistant)) associate 37
licensed under chapter 18.71A RCW; advanced emergency medical 38
technician or paramedic certified under chapter 18.71 RCW; or medical 39
p. 89 HB 2127
assistant-certified or medical assistant-phlebotomist certified under 1
chapter 18.360 RCW, person holding another credential under Title 18 2
RCW whose scope of practice includes performing venous blood draws, 3
or forensic phlebotomist certified under chapter 18.360 RCW, or 4
hospital, or duly licensed clinical laboratory employing or utilizing 5
services of such licensed or certified health care provider, shall 6
incur any civil or criminal liability as a result of the act of 7
withdrawing blood from any person when directed by a law enforcement 8
officer to do so for the purpose of a blood test under the provisions 9
of a search warrant, a waiver of the search warrant requirement, 10
exigent circumstances, or any other authority of law: PROVIDED, That 11
nothing in this section shall relieve such licensed or certified 12
health care provider, hospital or duly licensed clinical laboratory, 13
or forensic phlebotomist from civil liability arising from the use of 14
improper procedures or failing to exercise the required standard of 15
care. 16
Sec. 63. RCW 48.20.392 and 2025 c 58 s 5099 are each amended to 17
read as follows: 18
(1) Each disability insurance policy issued or renewed after 19
December 31, 2006, that provides coverage for hospital or medical 20
expenses shall provide coverage for prostate cancer screening, 21
provided that the screening is delivered upon the recommendation of 22
the patient's physician, advanced practice registered nurse, or 23
physician ((assistant)) associate. 24
(2) This section shall not be construed to prevent the 25
application of standard policy provisions applicable to other 26
benefits, such as deductible or copayment provisions. This section 27
does not limit the authority of an insurer to negotiate rates and 28
contract with specific providers for the delivery of prostate cancer 29
screening services. This section shall not apply to medicare 30
supplemental policies or supplemental contracts covering a specified 31
disease or other limited benefits. 32
Sec. 64. RCW 48.20.393 and 2025 c 58 s 5100 are each amended to 33
read as follows: 34
Each disability insurance policy issued or renewed after January 35
1, 1990, that provides coverage for hospital or medical expenses 36
shall provide coverage for screening or diagnostic mammography 37
services, provided that such services are delivered upon the 38
p. 90 HB 2127
recommendation of the patient's physician or advanced practice 1
registered nurse as authorized by the state board of nursing pursuant 2
to chapter 18.79 RCW or physician ((assistant)) associate pursuant to 3
chapter 18.71A RCW. 4
This section shall not be construed to prevent the application of 5
standard policy provisions, other than the cost-sharing prohibition 6
provided in RCW 48.43.076, that are applicable to other benefits. 7
This section does not limit the authority of an insurer to negotiate 8
rates and contract with specific providers for the delivery of 9
mammography services. This section shall not apply to medicare 10
supplement policies or supplemental contracts covering a specified 11
disease or other limited benefits. 12
Sec. 65. RCW 48.21.225 and 2025 c 58 s 5101 are each amended to 13
read as follows: 14
Each group disability insurance policy issued or renewed after 15
January 1, 1990, that provides coverage for hospital or medical 16
expenses shall provide coverage for screening or diagnostic 17
mammography services, provided that such services are delivered upon 18
the recommendation of the patient's physician or advanced practice 19
registered nurse as authorized by the state board of nursing pursuant 20
to chapter 18.79 RCW or physician ((assistant)) associate pursuant to 21
chapter 18.71A RCW. 22
This section shall not be construed to prevent the application of 23
standard policy provisions, other than the cost-sharing prohibition 24
provided in RCW 48.43.076, that are applicable to other benefits. 25
This section does not limit the authority of an insurer to negotiate 26
rates and contract with specific providers for the delivery of 27
mammography services. This section shall not apply to medicare 28
supplement policies or supplemental contracts covering a specified 29
disease or other limited benefits. 30
Sec. 66. RCW 48.21.227 and 2025 c 58 s 5102 are each amended to 31
read as follows: 32
(1) Each group disability insurance policy issued or renewed 33
after December 31, 2006, that provides coverage for hospital or 34
medical expenses shall provide coverage for prostate cancer 35
screening, provided that the screening is delivered upon the 36
recommendation of the patient's physician, advanced practice 37
registered nurse, or physician ((assistant)) associate.38
p. 91 HB 2127
(2) This section shall not be construed to prevent the 1
application of standard policy provisions applicable to other 2
benefits, such as deductible or copayment provisions. This section 3
does not limit the authority of an insurer to negotiate rates and 4
contract with specific providers for the delivery of prostate cancer 5
screening services. This section shall not apply to medicare 6
supplemental policies or supplemental contracts covering a specified 7
disease or other limited benefits. 8
Sec. 67. RCW 48.43.835 and 2024 c 62 s 11 are each amended to 9
read as follows: 10
This chapter authorizes carriers to reimburse employers of 11
physician ((assistants)) associates for covered services rendered by 12
licensed physician ((assistants)) associates. Payment for services 13
within the physician ((assistant's)) associate's scope of practice 14
must be made when ordered or performed by a physician ((assistant)) 15
associate if the same services would have been covered if ordered or 16
performed by a physician. Physician ((assistants)) associates or 17
their employers, who are billing on behalf of the physician 18
((assistant)) associate, are authorized to bill for and receive 19
direct payment for the services delivered by physician ((assistants)) 20
associates. A carrier may not impose a practice, education, or 21
collaboration requirement that is inconsistent with or more 22
restrictive than state laws or regulations governing physician 23
((assistants)) associates. 24
Sec. 68. RCW 48.44.325 and 2025 c 58 s 5106 are each amended to 25
read as follows: 26
Each health care service contract issued or renewed after January 27
1, 1990, that provides benefits for hospital or medical care shall 28
provide benefits for screening or diagnostic mammography services, 29
provided that such services are delivered upon the recommendation of 30
the patient's physician or advanced practice registered nurse as 31
authorized by the state board of nursing pursuant to chapter 18.79 32
RCW or physician ((assistant)) associate pursuant to chapter 18.71A 33
RCW. 34
This section shall not be construed to prevent the application of 35
standard contract provisions, other than the cost-sharing prohibition 36
provided in RCW 48.43.076, that are applicable to other benefits. 37
This section does not limit the authority of a contractor to 38
p. 92 HB 2127
negotiate rates and contract with specific providers for the delivery 1
of mammography services. This section shall not apply to medicare 2
supplement policies or supplemental contracts covering a specified 3
disease or other limited benefits. 4
Sec. 69. RCW 48.44.327 and 2025 c 58 s 5107 are each amended to 5
read as follows: 6
(1) Each health care service contract issued or renewed after 7
December 31, 2006, that provides coverage for hospital or medical 8
expenses shall provide coverage for prostate cancer screening, 9
provided that the screening is delivered upon the recommendation of 10
the patient's physician, advanced practice registered nurse, or 11
physician ((assistant)) associate. 12
(2) This section shall not be construed to prevent the 13
application of standard policy provisions applicable to other 14
benefits, such as deductible or copayment provisions. This section 15
does not limit the authority of a contractor to negotiate rates and 16
contract with specific providers for the delivery of prostate cancer 17
screening services. This section shall not apply to medicare 18
supplemental policies or supplemental contracts covering a specified 19
disease or other limited benefits. 20
Sec. 70. RCW 48.46.275 and 2025 c 58 s 5108 are each amended to 21
read as follows: 22
Each health maintenance agreement issued or renewed after January 23
1, 1990, that provides benefits for hospital or medical care shall 24
provide benefits for screening or diagnostic mammography services, 25
provided that such services are delivered upon the recommendation of 26
the patient's physician or advanced practice registered nurse as 27
authorized by the state board of nursing pursuant to chapter 18.79 28
RCW or physician ((assistant)) associate pursuant to chapter 18.71A 29
RCW. 30
All services must be provided by the health maintenance 31
organization or rendered upon referral by the health maintenance 32
organization. This section shall not be construed to prevent the 33
application of standard agreement provisions, other than the cost-34
sharing prohibition provided in RCW 48.43.076, that are applicable to 35
other benefits. This section does not limit the authority of a health 36
maintenance organization to negotiate rates and contract with 37
specific providers for the delivery of mammography services. This 38
p. 93 HB 2127
section shall not apply to medicare supplement policies or 1
supplemental contracts covering a specified disease or other limited 2
benefits. 3
Sec. 71. RCW 48.46.277 and 2025 c 58 s 5109 are each amended to 4
read as follows: 5
(1) Each health maintenance agreement issued or renewed after 6
December 31, 2006, that provides coverage for hospital or medical 7
expenses shall provide coverage for prostate cancer screening, 8
provided that the screening is delivered upon the recommendation of 9
the patient's physician, advanced practice registered nurse, or 10
physician ((assistant)) associate. 11
(2) All services must be provided by the health maintenance 12
organization or rendered upon a referral by the health maintenance 13
organization. 14
(3) This section shall not be construed to prevent the 15
application of standard policy provisions applicable to other 16
benefits, such as deductible or copayment provisions. This section 17
does not limit the authority of a health maintenance organization to 18
negotiate rates and contract with specific providers for the delivery 19
of prostate cancer screening services. This section shall not apply 20
to medicare supplemental policies or supplemental contracts covering 21
a specified disease or other limited benefits. 22
Sec. 72. RCW 48.125.200 and 2025 c 58 s 5110 are each amended to 23
read as follows: 24
(1) Each self-funded multiple employer welfare arrangement 25
established, operated, providing benefits, or maintained in this 26
state after December 31, 2006, that provides coverage for hospital or 27
medical expenses shall provide coverage for prostate cancer 28
screening, provided that the screening is delivered upon the 29
recommendation of the patient's physician, advanced practice 30
registered nurse, or physician ((assistant)) associate.31
(2) This section shall not be construed to prevent the 32
application of standard policy provisions applicable to other 33
benefits, such as deductible or copayment provisions. This section 34
does not limit the authority of a self-funded multiple employer 35
welfare arrangement to negotiate rates and contract with specific 36
providers for the delivery of prostate cancer screening services.37
p. 94 HB 2127
Sec. 73. RCW 51.04.030 and 2025 c 58 s 5112 are each amended to 1
read as follows: 2
(1) The director shall supervise the providing of prompt and 3
efficient care and treatment, including care provided by physician 4
((assistants)) associates governed by the provisions of chapter 5
18.71A RCW, including chiropractic care, and including care provided 6
by licensed advanced practice registered nurses, to workers injured 7
during the course of their employment at the least cost consistent 8
with promptness and efficiency, without discrimination or favoritism, 9
and with as great uniformity as the various and diverse surrounding 10
circumstances and locations of industries will permit and to that end 11
shall, from time to time, establish and adopt and supervise the 12
administration of printed forms, rules, regulations, and practices 13
for the furnishing of such care and treatment: PROVIDED, That the 14
medical coverage decisions of the department do not constitute a 15
"rule" as used in RCW 34.05.010(16), nor are such decisions subject 16
to the rule-making provisions of chapter 34.05 RCW except that 17
criteria for establishing medical coverage decisions shall be adopted 18
by rule after consultation with the workers' compensation advisory 19
committee established in RCW 51.04.110: PROVIDED FURTHER, That the 20
department may recommend to an injured worker particular health care 21
services and providers where specialized treatment is indicated or 22
where cost-effective payment levels or rates are obtained by the 23
department: AND PROVIDED FURTHER, That the department may enter into 24
contracts for goods and services including, but not limited to, 25
durable medical equipment so long as statewide access to quality 26
service is maintained for injured workers. 27
(2) The director shall, in consultation with interested persons, 28
establish and, in his or her discretion, periodically change as may 29
be necessary, and make available a fee schedule of the maximum 30
charges to be made by any physician, surgeon, chiropractor, hospital, 31
druggist, licensed advanced practice registered nurse, physician 32
((assistants)) associates as defined in chapter 18.71A RCW, acting 33
under the supervision of or in coordination with a participating 34
physician, as defined in RCW 18.71A.010, or other agency or person 35
rendering services to injured workers. The department shall 36
coordinate with other state purchasers of health care services to 37
establish as much consistency and uniformity in billing and coding 38
practices as possible, taking into account the unique requirements 39
and differences between programs. No service covered under this 40
p. 95 HB 2127
title, including services provided to injured workers, whether aliens 1
or other injured workers, who are not residing in the United States 2
at the time of receiving the services, shall be charged or paid at a 3
rate or rates exceeding those specified in such fee schedule, and no 4
contract providing for greater fees shall be valid as to the excess. 5
The establishment of such a schedule, exclusive of conversion 6
factors, does not constitute "agency action" as used in RCW 7
34.05.010(3), nor does such a fee schedule and its associated billing 8
or payment instructions and policies constitute a "rule" as used in 9
RCW 34.05.010(16). 10
(3) The director or self-insurer, as the case may be, shall make 11
a record of the commencement of every disability and the termination 12
thereof and, when bills are rendered for the care and treatment of 13
injured workers, shall approve and pay those which conform to the 14
adopted rules, regulations, established fee schedules, and practices 15
of the director and may reject any bill or item thereof incurred in 16
violation of the principles laid down in this section or the rules, 17
regulations, or the established fee schedules and rules and 18
regulations adopted under it. 19
Sec. 74. RCW 51.08.200 and 2023 c 171 s 2 are each amended to 20
read as follows: 21
"Attending provider" means a person who is a member of the health 22
care provider network established under RCW 51.36.010, is treating 23
injured workers within the person's scope of practice, and is 24
licensed under Title 18 RCW in one of the following professions: 25
Physicians, chapter 18.71 RCW; osteopathy, chapter 18.57 RCW; 26
chiropractic, chapter 18.25 RCW; naturopathy, chapter 18.36A RCW; 27
podiatric medicine and surgery, chapter 18.22 RCW; dentistry, chapter 28
18.32 RCW; optometry, chapter 18.53 RCW; in the case of claims solely 29
for mental health conditions, psychology, chapter 18.83 RCW; 30
physician ((assistants)) associates, chapter 18.71A RCW; and licensed 31
advanced practice registered nurse s ((practitioners)), chapter 18.79 32
RCW. 33
Sec. 75. RCW 51.28.010 and 2025 c 58 s 5113 are each amended to 34
read as follows: 35
(1) Whenever any accident occurs to any worker it shall be the 36
duty of such worker or someone in his or her behalf to forthwith 37
report such accident to his or her employer, superintendent, or 38
p. 96 HB 2127
supervisor in charge of the work, and of the employer to at once 1
report such accident and the injury resulting therefrom to the 2
department pursuant to RCW 51.28.025 where the worker has received 3
treatment from a physician, osteopathic physician, chiropractor, 4
naturopath, podiatric physician, optometrist, dentist, licensed 5
advanced practice registered nurse, physician ((assistant)) 6
associate, or psychologist in claims solely for mental health 7
conditions, has been hospitalized, disabled from work, or has died as 8
the apparent result of such accident and injury. 9
(2) Upon receipt of such notice of accident, the department shall 10
immediately forward to the worker or his or her beneficiaries or 11
dependents notification, in nontechnical language, of their rights 12
under this title. The notice must specify the worker's right to 13
receive health services from a provider of the worker's choice under 14
RCW 51.36.010(2)(a), including chiropractic services under RCW 15
51.36.015, and must list the types of providers authorized to provide 16
these services. 17
(3) Employers shall not engage in claim suppression.18
(4) For the purposes of this section, "claim suppression" means 19
intentionally: 20
(a) Inducing employees to fail to report injuries;21
(b) Inducing employees to treat injuries in the course of 22
employment as off-the-job injuries; or 23
(c) Acting otherwise to suppress legitimate industrial insurance 24
claims. 25
(5) In determining whether an employer has engaged in claim 26
suppression, the department shall consider the employer's history of 27
compliance with industrial insurance reporting requirements, and 28
whether the employer has discouraged employees from reporting 29
injuries or filing claims. The department has the burden of proving 30
claim suppression by a preponderance of the evidence.31
(6) Claim suppression does not include bona fide workplace safety 32
and accident prevention programs or an employer's provision at the 33
worksite of first aid as defined by the department. The department 34
shall adopt rules defining bona fide workplace safety and accident 35
prevention programs and defining first aid. 36
Sec. 76. RCW 51.28.020 and 2025 c 58 s 5114 are each amended to 37
read as follows: 38
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(1)(a) Where a worker is entitled to compensation under this 1
title he or she shall file with the department or his or her self-2
insured employer, as the case may be, his or her application for 3
such, together with the certificate of the physician, osteopathic 4
physician, chiropractor, naturopath, podiatric physician, 5
optometrist, dentist, licensed advanced practice registered nurse, 6
physician ((assistant)) associate, or psychologist in claims solely 7
for mental health conditions, who attended him or her. An application 8
form developed by the department shall include a notice specifying 9
the worker's right to receive health services from a provider of the 10
worker's choice under RCW 51.36.010(2)(a), and listing the types of 11
providers authorized to provide these services. 12
(b) The physician, osteopathic physician, chiropractor, 13
naturopath, podiatric physician, optometrist, dentist, licensed 14
advanced practice registered nurse, physician ((assistant)) 15
associate, or psychologist in claims solely for mental health 16
conditions, who attended the injured worker shall inform the injured 17
worker of his or her rights under this title and lend all necessary 18
assistance in making this application for compensation and such proof 19
of other matters as required by the rules of the department without 20
charge to the worker. The department shall provide a manual which 21
outlines the procedures to be followed in applications for 22
compensation involving occupational diseases, and which describes 23
claimants' rights and responsibilities related to occupational 24
disease claims. 25
(2) If the application required by this section is:26
(a) Made to the department and the employer has not received a 27
copy of the application, the department shall immediately send a copy 28
of the application to the employer; or 29
(b) Made to a self-insured employer, the employer shall forthwith 30
send a copy of the application to the department. 31
(3) The application required by this section may be transmitted 32
to the department electronically. 33
Sec. 77. RCW 51.28.100 and 2024 c 62 s 12 are each amended to 34
read as follows: 35
The department shall accept the signature of a physician 36
((assistant)) associate on any certificate, card, form, or other 37
documentation required by the department that the physician 38
((assistant's)) associate's participating physician or physicians, as 39
p. 98 HB 2127
defined in RCW 18.71A.010, may sign, provided that it is within the 1
physician ((assistant's)) associate's scope of practice, and is 2
consistent with the terms of the physician ((assistant's)) 3
associate's collaboration agreement as required by chapter 18.71A 4
RCW. Consistent with the terms of this section, the authority of a 5
physician ((assistant)) associate to sign such certificates, cards, 6
forms, or other documentation includes, but is not limited to, the 7
execution of the certificate required in RCW 51.28.020. A physician 8
((assistant)) associate may not rate a worker's permanent partial 9
disability under RCW 51.32.055. 10
Sec. 78. RCW 51.36.010 and 2025 c 58 s 5117 are each amended to 11
read as follows: 12
(1) The legislature finds that high quality medical treatment and 13
adherence to occupational health best practices can prevent 14
disability and reduce loss of family income for workers, and lower 15
labor and insurance costs for employers. Injured workers deserve high 16
quality medical care in accordance with current health care best 17
practices. To this end, the department shall establish minimum 18
standards for providers who treat workers from both state fund and 19
self-insured employers. The department shall establish a health care 20
provider network to treat injured workers, and shall accept providers 21
into the network who meet those minimum standards. The department 22
shall convene an advisory group made up of representatives from or 23
designees of the workers' compensation advisory committee and the 24
industrial insurance medical and chiropractic advisory committees to 25
consider and advise the department related to implementation of this 26
section, including development of best practices treatment guidelines 27
for providers in the network. The department shall also seek the 28
input of various health care provider groups and associations 29
concerning the network's implementation. Network providers must be 30
required to follow the department's evidence-based coverage decisions 31
and treatment guidelines, policies, and must be expected to follow 32
other national treatment guidelines appropriate for their patient. 33
The department, in collaboration with the advisory group, shall also 34
establish additional best practice standards for providers to qualify 35
for a second tier within the network, based on demonstrated use of 36
occupational health best practices. This second tier is separate from 37
and in addition to the centers for occupational health and education 38
established under subsection (5) of this section. 39
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(2)(a) Upon the occurrence of any injury to a worker entitled to 1
compensation under the provisions of this title, he or she shall 2
receive proper and necessary medical and surgical services at the 3
hands of a physician, osteopathic physician, chiropractor, 4
naturopath, podiatric physician, optometrist, dentist, licensed 5
advanced practice registered nurse, physician ((assistant)) 6
associate, or psychologist in claims solely for mental health 7
conditions, of his or her own choice, if conveniently located, except 8
as provided in (b) of this subsection, and proper and necessary 9
hospital care and services during the period of his or her disability 10
from such injury. 11
(b) Once the provider network is established in the worker's 12
geographic area, an injured worker may receive care from a nonnetwork 13
provider only for an initial office or emergency room visit. However, 14
the department or self-insurer may limit reimbursement to the 15
department's standard fee for the services. The provider must comply 16
with all applicable billing policies and must accept the department's 17
fee schedule as payment in full. 18
(c) The department, in collaboration with the advisory group, 19
shall adopt policies for the development, credentialing, 20
accreditation, and continued oversight of a network of health care 21
providers approved to treat injured workers. Health care providers 22
shall apply to the network by completing the department's provider 23
application which shall have the force of a contract with the 24
department to treat injured workers. The advisory group shall 25
recommend minimum network standards for the department to approve a 26
provider's application, to remove a provider from the network, or to 27
require peer review such as, but not limited to: 28
(i) Current malpractice insurance coverage exceeding a dollar 29
amount threshold, number, or seriousness of malpractice suits over a 30
specific time frame; 31
(ii) Previous malpractice judgments or settlements that do not 32
exceed a dollar amount threshold recommended by the advisory group, 33
or a specific number or seriousness of malpractice suits over a 34
specific time frame; 35
(iii) No licensing or disciplinary action in any jurisdiction or 36
loss of treating or admitting privileges by any board, commission, 37
agency, public or private health care payer, or hospital;38
(iv) For some specialties such as surgeons, privileges in at 39
least one hospital; 40
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(v) Whether the provider has been credentialed by another health 1
plan that follows national quality assurance guidelines; and2
(vi) Alternative criteria for providers that are not credentialed 3
by another health plan. 4
The department shall develop alternative criteria for providers 5
that are not credentialed by another health plan or as needed to 6
address access to care concerns in certain regions.7
(d) Network provider contracts will automatically renew at the 8
end of the contract period unless the department provides written 9
notice of changes in contract provisions or the department or 10
provider provides written notice of contract termination. The 11
industrial insurance medical advisory committee shall develop 12
criteria for removal of a provider from the network to be presented 13
to the department and advisory group for consideration in the 14
development of contract terms. 15
(e) In order to monitor quality of care and assure efficient 16
management of the provider network, the department shall establish 17
additional criteria and terms for network participation including, 18
but not limited to, requiring compliance with administrative and 19
billing policies. 20
(f) The advisory group shall recommend best practices standards 21
to the department to use in determining second tier network 22
providers. The department shall develop and implement financial and 23
nonfinancial incentives for network providers who qualify for the 24
second tier. The department is authorized to certify and decertify 25
second tier providers. 26
(3) The department shall work with self-insurers and the 27
department utilization review provider to implement utilization 28
review for the self-insured community to ensure consistent quality, 29
cost-effective care for all injured workers and employers, and to 30
reduce administrative burden for providers. 31
(4) The department for state fund claims shall pay, in accordance 32
with the department's fee schedule, for any alleged injury for which 33
a worker files a claim, any initial prescription drugs provided in 34
relation to that initial visit, without regard to whether the 35
worker's claim for benefits is allowed. In all accepted claims, 36
treatment shall be limited in point of duration as follows:37
In the case of permanent partial disability, not to extend beyond 38
the date when compensation shall be awarded him or her, except when 39
the worker returned to work before permanent partial disability award 40
p. 101 HB 2127
is made, in such case not to extend beyond the time when monthly 1
allowances to him or her shall cease; in case of temporary disability 2
not to extend beyond the time when monthly allowances to him or her 3
shall cease: PROVIDED, That after any injured worker has returned to 4
his or her work his or her medical and surgical treatment may be 5
continued if, and so long as, such continuation is deemed necessary 6
by the supervisor of industrial insurance to be necessary to his or 7
her more complete recovery; in case of a permanent total disability 8
not to extend beyond the date on which a lump sum settlement is made 9
with him or her or he or she is placed upon the permanent pension 10
roll: PROVIDED, HOWEVER, That the supervisor of industrial insurance, 11
solely in his or her discretion, may authorize continued medical and 12
surgical treatment for conditions previously accepted by the 13
department when such medical and surgical treatment is deemed 14
necessary by the supervisor of industrial insurance to protect such 15
worker's life or provide for the administration of medical and 16
therapeutic measures including payment of prescription medications, 17
but not including those controlled substances currently scheduled by 18
the pharmacy quality assurance commission as Schedule I, II, III, or 19
IV substances under chapter 69.50 RCW, which are necessary to 20
alleviate continuing pain which results from the industrial injury. 21
In order to authorize such continued treatment the written order of 22
the supervisor of industrial insurance issued in advance of the 23
continuation shall be necessary. 24
The supervisor of industrial insurance, the supervisor's 25
designee, or a self-insurer, in his or her sole discretion, may 26
authorize inoculation or other immunological treatment in cases in 27
which a work-related activity has resulted in probable exposure of 28
the worker to a potential infectious occupational disease. 29
Authorization of such treatment does not bind the department or self-30
insurer in any adjudication of a claim by the same worker or the 31
worker's beneficiary for an occupational disease. 32
(5)(a) The legislature finds that the department and its business 33
and labor partners have collaborated in establishing centers for 34
occupational health and education to promote best practices and 35
prevent preventable disability by focusing additional provider-based 36
resources during the first twelve weeks following an injury. The 37
centers for occupational health and education represent innovative 38
accountable care systems in an early stage of development consistent 39
p. 102 HB 2127
with national health care reform efforts. Many Washington workers do 1
not yet have access to these innovative health care delivery models.2
(b) To expand evidence-based occupational health best practices, 3
the department shall establish additional centers for occupational 4
health and education, with the goal of extending access to at least 5
fifty percent of injured and ill workers by December 2013 and to all 6
injured workers by December 2015. The department shall also develop 7
additional best practices and incentives that span the entire period 8
of recovery, not only the first twelve weeks. 9
(c) The department shall certify and decertify centers for 10
occupational health and education based on criteria including 11
institutional leadership and geographic areas covered by the center 12
for occupational health and education, occupational health leadership 13
and education, mix of participating health care providers necessary 14
to address the anticipated needs of injured workers, health services 15
coordination to deliver occupational health best practices, 16
indicators to measure the success of the center for occupational 17
health and education, and agreement that the center's providers 18
shall, if feasible, treat certain injured workers if referred by the 19
department or a self-insurer. 20
(d) Health care delivery organizations may apply to the 21
department for certification as a center for occupational health and 22
education. These may include, but are not limited to, hospitals and 23
affiliated clinics and providers, multispecialty clinics, health 24
maintenance organizations, and organized systems of network 25
physicians. 26
(e) The centers for occupational health and education shall 27
implement benchmark quality indicators of occupational health best 28
practices for individual providers, developed in collaboration with 29
the department. A center for occupational health and education shall 30
remove individual providers who do not consistently meet these 31
quality benchmarks. 32
(f) The department shall develop and implement financial and 33
nonfinancial incentives for center for occupational health and 34
education providers that are based on progressive and measurable 35
gains in occupational health best practices, and that are applicable 36
throughout the duration of an injured or ill worker's episode of 37
care. 38
(g) The department shall develop electronic methods of tracking 39
evidence-based quality measures to identify and improve outcomes for 40
p. 103 HB 2127
injured workers at risk of developing prolonged disability. In 1
addition, these methods must be used to provide systematic feedback 2
to physicians regarding quality of care, to conduct appropriate 3
objective evaluation of progress in the centers for occupational 4
health and education, and to allow efficient coordination of 5
services. 6
(6) If a provider fails to meet the minimum network standards 7
established in subsection (2) of this section, the department is 8
authorized to remove the provider from the network or take other 9
appropriate action regarding a provider's participation. The 10
department may also require remedial steps as a condition for a 11
provider to participate in the network. The department, with input 12
from the advisory group, shall establish waiting periods that may be 13
imposed before a provider who has been denied or removed from the 14
network may reapply. 15
(7) The department may permanently remove a provider from the 16
network or take other appropriate action when the provider exhibits a 17
pattern of conduct of low quality care that exposes patients to risk 18
of physical or psychiatric harm or death. Patterns that qualify as 19
risk of harm include, but are not limited to, poor health care 20
outcomes evidenced by increased, chronic, or prolonged pain or 21
decreased function due to treatments that have not been shown to be 22
curative, safe, or effective or for which it has been shown that the 23
risks of harm exceed the benefits that can be reasonably expected 24
based on peer-reviewed opinion. 25
(8) The department may not remove a health care provider from the 26
network for an isolated instance of poor health and recovery outcomes 27
due to treatment by the provider. 28
(9) When the department terminates a provider from the network, 29
the department or self-insurer shall assist an injured worker 30
currently under the provider's care in identifying a new network 31
provider or providers from whom the worker can select an attending or 32
treating provider. In such a case, the department or self-insurer 33
shall notify the injured worker that he or she must choose a new 34
attending or treating provider. 35
(10) The department may adopt rules related to this section.36
(11) The department shall report to the workers' compensation 37
advisory committee and to the appropriate committees of the 38
legislature on each December 1st, beginning in 2012 and ending in 39
2016, on the implementation of the provider network and expansion of 40
p. 104 HB 2127
the centers for occupational health and education. The reports must 1
include a summary of actions taken, progress toward long-term goals, 2
outcomes of key initiatives, access to care issues, results of 3
disputes or controversies related to new provisions, and whether any 4
changes are needed to further improve the occupational health best 5
practices care of injured workers. 6
Sec. 79. RCW 69.41.010 and 2025 c 58 s 5122 and 2025 c 26 s 1 7
are each reenacted and amended to read as follows: 8
As used in this chapter, the following terms have the meanings 9
indicated unless the context clearly requires otherwise:10
(1) "Administer" means the direct application of a legend drug 11
whether by injection, inhalation, ingestion, or any other means, to 12
the body of a patient or research subject by: 13
(a) A practitioner; or 14
(b) The patient or research subject at the direction of the 15
practitioner. 16
(2) "Commission" means the pharmacy quality assurance commission.17
(3) "Community-based care settings" include: Community 18
residential programs for persons with developmental disabilities, 19
certified by the department of social and health services under 20
chapter 71A.12 RCW; adult family homes licensed under chapter 70.128 21
RCW; and assisted living facilities licensed under chapter 18.20 RCW. 22
Community-based care settings do not include acute care or skilled 23
nursing facilities. 24
(4) "Deliver" or "delivery" means the actual, constructive, or 25
attempted transfer from one person to another of a legend drug, 26
whether or not there is an agency relationship. 27
(5) "Department" means the department of health.28
(6) "Dispense" means the interpretation of a prescription or 29
order for a legend drug and, pursuant to that prescription or order, 30
the proper selection, measuring, compounding, labeling, or packaging 31
necessary to prepare that prescription or order for delivery.32
(7) "Dispenser" means a practitioner who dispenses.33
(8) "Distribute" means to deliver other than by administering or 34
dispensing a legend drug. 35
(9) "Distributor" means a person who distributes.36
(10) "Drug" means: 37
(a) Substances recognized as drugs in the official United States 38
pharmacopoeia, official homeopathic pharmacopoeia of the United 39
p. 105 HB 2127
States, or official national formulary, or any supplement to any of 1
them; 2
(b) Substances intended for use in the diagnosis, cure, 3
mitigation, treatment, or prevention of disease in human beings or 4
animals; 5
(c) Substances (other than food, minerals or vitamins) intended 6
to affect the structure or any function of the body of human beings 7
or animals; and 8
(d) Substances intended for use as a component of any article 9
specified in (a), (b), or (c) of this subsection. It does not include 10
devices or their components, parts, or accessories.11
(11) "Electronic communication of prescription information" means 12
the transmission of a prescription or refill authorization for a drug 13
of a practitioner using computer systems. The term does not include a 14
prescription or refill authorization transmitted verbally by 15
telephone nor a facsimile manually signed by the practitioner.16
(12) "In-home care settings" include an individual's place of 17
temporary and permanent residence, but does not include acute care or 18
skilled nursing facilities, and does not include community-based care 19
settings. 20
(13) "Legend drugs" means any drugs which are required by state 21
law or regulation of the pharmacy quality assurance commission to be 22
dispensed on prescription only or are restricted to use by 23
practitioners only. 24
(14) "Legible prescription" means a prescription or medication 25
order issued by a practitioner that is capable of being read and 26
understood by the pharmacist filling the prescription or the nurse or 27
other practitioner implementing the medication order. A prescription 28
must be hand printed, typewritten, or electronically generated.29
(15) "Medication assistance" means assistance rendered by a 30
nonpractitioner to an individual residing in a community-based care 31
setting or in-home care setting to facilitate the individual's self-32
administration of a legend drug or legend drugs, which may include a 33
controlled substance or controlled substances. It includes reminding 34
or coaching the individual, handing the medication container to the 35
individual, opening the individual's medication container, using an 36
enabler, or placing the medication in the individual's hand, and such 37
other means of medication assistance as defined by rule adopted by 38
the department. A nonpractitioner may help in the preparation of 39
legend drugs, including controlled substances, for self-40
p. 106 HB 2127
administration where a practitioner has determined and communicated 1
orally or by written direction that such medication preparation 2
assistance is necessary and appropriate. Medication assistance shall 3
not include assistance with intravenous medications or injectable 4
medications, except setting up diabetic devices for self-5
administration or handling injectable medications to an individual 6
for self-administration. 7
(16) "Person" means individual, corporation, government or 8
governmental subdivision or agency, business trust, estate, trust, 9
partnership or association, or any other legal entity.10
(17) "Practitioner" means: 11
(a) A physician under chapter 18.71 RCW, an osteopathic physician 12
or an osteopathic physician and surgeon under chapter 18.57 RCW, a 13
dentist under chapter 18.32 RCW, a podiatric physician and surgeon 14
under chapter 18.22 RCW, an acupuncturist or acupuncture and Eastern 15
medicine practitioner to the extent authorized under chapter 18.06 16
RCW and the rules adopted under RCW 18.06.010(1)(m), a veterinarian 17
under chapter 18.92 RCW, a registered nurse, advanced practice 18
registered nurse, or licensed practical nurse under chapter 18.79 19
RCW, an optometrist under chapter 18.53 RCW who is certified by the 20
optometry board under RCW 18.53.010, a physician ((assistant)) 21
associate under chapter 18.71A RCW, a naturopath licensed under 22
chapter 18.36A RCW, a licensed athletic trainer to the extent 23
authorized under chapter 18.250 RCW, a pharmacist under chapter 18.64 24
RCW, when acting under the required supervision of a dentist licensed 25
under chapter 18.32 RCW, a dental hygienist licensed under chapter 26
18.29 RCW, a licensed dental therapist to the extent authorized under 27
chapter 18.265 RCW, or a licensed midwife to the extent authorized 28
under chapter 18.50 RCW; 29
(b) A pharmacy, hospital, or other institution licensed, 30
registered, or otherwise permitted to distribute, dispense, conduct 31
research with respect to, or to administer a legend drug in the 32
course of professional practice or research in this state; and33
(c) A physician licensed to practice medicine and surgery or a 34
physician licensed to practice osteopathic medicine and surgery in 35
any state, or province of Canada, which shares a common border with 36
the state of Washington. 37
(18) "Secretary" means the secretary of health or the secretary's 38
designee. 39
p. 107 HB 2127
Sec. 80. RCW 69.41.030 and 2025 c 58 s 5123 are each amended to 1
read as follows: 2
(1) It shall be unlawful for any person to sell or deliver any 3
legend drug, or knowingly possess any legend drug, or knowingly use 4
any legend drug in a public place, except upon the order or 5
prescription of a physician under chapter 18.71 RCW, an osteopathic 6
physician and surgeon under chapter 18.57 RCW, an optometrist 7
licensed under chapter 18.53 RCW who is certified by the optometry 8
board under RCW 18.53.010, a dentist under chapter 18.32 RCW, a 9
podiatric physician and surgeon under chapter 18.22 RCW, a licensed 10
midwife to the extent authorized under chapter 18.50 RCW, a 11
veterinarian under chapter 18.92 RCW, a commissioned medical or 12
dental officer in the United States armed forces or public health 13
service in the discharge of his or her official duties, a duly 14
licensed physician or dentist employed by the veterans administration 15
in the discharge of his or her official duties, a registered nurse or 16
advanced practice registered nurse under chapter 18.79 RCW when 17
authorized by the board of nursing, a pharmacist licensed under 18
chapter 18.64 RCW to the extent permitted by drug therapy guidelines 19
or protocols established under RCW 18.64.011 and authorized by the 20
commission and approved by a practitioner authorized to prescribe 21
drugs, a physician ((assistant)) associate under chapter 18.71A RCW 22
when authorized by the Washington medical commission, or any of the 23
following professionals in any province of Canada that shares a 24
common border with the state of Washington or in any state of the 25
United States: A physician licensed to practice medicine and surgery 26
or a physician licensed to practice osteopathic medicine and surgery, 27
a dentist licensed to practice dentistry, a podiatric physician and 28
surgeon licensed to practice podiatric medicine and surgery, a 29
licensed advanced practice registered nurse, a licensed physician 30
((assistant)) associate, or a veterinarian licensed to practice 31
veterinary medicine: PROVIDED, HOWEVER, That the above provisions 32
shall not apply to sale, delivery, or possession by drug wholesalers 33
or drug manufacturers, or their agents or employees, or to any 34
practitioner acting within the scope of his or her license, or to a 35
common or contract carrier or warehouse operator, or any employee 36
thereof, whose possession of any legend drug is in the usual course 37
of business or employment: PROVIDED FURTHER, That nothing in this 38
chapter or chapter 18.64 RCW shall prevent a family planning clinic 39
that is under contract with the health care authority from selling, 40
p. 108 HB 2127
delivering, possessing, and dispensing commercially prepackaged oral 1
contraceptives prescribed by authorized, licensed health care 2
practitioners: PROVIDED FURTHER, That nothing in this chapter 3
prohibits possession or delivery of legend drugs by an authorized 4
collector or other person participating in the operation of a drug 5
take-back program authorized in chapter 69.48 RCW. 6
(2)(a) A violation of this section involving the sale, delivery, 7
or possession with intent to sell or deliver is a class B felony 8
punishable according to chapter 9A.20 RCW. 9
(b) A violation of this section involving knowing possession is a 10
misdemeanor. The prosecutor is encouraged to divert such cases for 11
assessment, treatment, or other services. 12
(c) A violation of this section involving knowing use in a public 13
place is a misdemeanor. The prosecutor is encouraged to divert such 14
cases for assessment, treatment, or other services.15
(d) No person may be charged with both knowing possession and 16
knowing use in a public place under this section relating to the same 17
course of conduct. 18
(e) In lieu of jail booking and referral to the prosecutor for a 19
violation of this section involving knowing possession, or knowing 20
use in a public place, law enforcement is encouraged to offer a 21
referral to assessment and services available under RCW 10.31.110 or 22
other program or entity responsible for receiving referrals in lieu 23
of legal system involvement, which may include, but are not limited 24
to, arrest and jail alternative programs established under RCW 25
36.28A.450, law enforcement assisted diversion programs established 26
under RCW 71.24.589, and the recovery navigator program established 27
under RCW 71.24.115. 28
(3) For the purposes of this section, "public place" has the same 29
meaning as defined in RCW 66.04.010, but the exclusions in RCW 30
66.04.011 do not apply. 31
(4) For the purposes of this section, "use any legend drug" means 32
to introduce the drug into the human body by injection, inhalation, 33
ingestion, or any other means. 34
Sec. 81. RCW 69.45.010 and 2025 c 58 s 5125 are each amended to 35
read as follows: 36
The definitions in this section apply throughout this chapter.37
(1) "Commission" means the pharmacy quality assurance commission.38
p. 109 HB 2127
(2) "Controlled substance" means a drug, substance, or immediate 1
precursor of such drug or substance, so designated under or pursuant 2
to chapter 69.50 RCW, the uniform controlled substances act.3
(3) "Deliver" or "delivery" means the actual, constructive, or 4
attempted transfer from one person to another of a drug or device, 5
whether or not there is an agency relationship. 6
(4) "Department" means the department of health.7
(5) "Dispense" means the interpretation of a prescription or 8
order for a drug, biological, or device and, pursuant to that 9
prescription or order, the proper selection, measuring, compounding, 10
labeling, or packaging necessary to prepare that prescription or 11
order for delivery. 12
(6) "Distribute" means to deliver, other than by administering or 13
dispensing, a legend drug. 14
(7) "Drug samples" means any federal food and drug administration 15
approved controlled substance, legend drug, or products requiring 16
prescriptions in this state, which is distributed at no charge to a 17
practitioner by a manufacturer or a manufacturer's representative, 18
exclusive of drugs under clinical investigations approved by the 19
federal food and drug administration. 20
(8) "Legend drug" means any drug that is required by state law or 21
by regulations of the commission to be dispensed on prescription only 22
or is restricted to use by practitioners only. 23
(9) "Manufacturer" means a person or other entity engaged in the 24
manufacture or distribution of drugs or devices, but does not include 25
a manufacturer's representative. 26
(10) "Manufacturer's representative" means an agent or employee 27
of a drug manufacturer who is authorized by the drug manufacturer to 28
possess drug samples for the purpose of distribution in this state to 29
appropriately authorized health care practitioners.30
(11) "Person" means any individual, corporation, government or 31
governmental subdivision or agency, business trust, estate, trust, 32
partnership, association, or any other legal entity.33
(12) "Practitioner" means a physician under chapter 18.71 RCW, an 34
osteopathic physician or an osteopathic physician and surgeon under 35
chapter 18.57 RCW, a dentist under chapter 18.32 RCW, a podiatric 36
physician and surgeon under chapter 18.22 RCW, a veterinarian under 37
chapter 18.92 RCW, a pharmacist under chapter 18.64 RCW, a 38
commissioned medical or dental officer in the United States armed 39
forces or the public health service in the discharge of his or her 40
p. 110 HB 2127
official duties, a duly licensed physician or dentist employed by the 1
veterans administration in the discharge of his or her official 2
duties, a registered nurse or advanced practice registered nurse 3
under chapter 18.79 RCW when authorized to prescribe by the state 4
board of nursing, or a physician ((assistant)) associate under 5
chapter 18.71A RCW when authorized by the Washington medical 6
commission. 7
(13) "Reasonable cause" means a state of facts found to exist 8
that would warrant a reasonably intelligent and prudent person to 9
believe that a person has violated state or federal drug laws or 10
regulations. 11
(14) "Secretary" means the secretary of health or the secretary's 12
designee. 13
Sec. 82. RCW 69.50.101 and 2025 c 58 s 5126 are each amended to 14
read as follows: 15
The definitions in this section apply throughout this chapter 16
unless the context clearly requires otherwise. 17
(1) "Administer" means to apply a controlled substance, whether 18
by injection, inhalation, ingestion, or any other means, directly to 19
the body of a patient or research subject by: 20
(a) a practitioner authorized to prescribe (or, by the 21
practitioner's authorized agent); or 22
(b) the patient or research subject at the direction and in the 23
presence of the practitioner. 24
(2) "Agent" means an authorized person who acts on behalf of or 25
at the direction of a manufacturer, distributor, or dispenser. It 26
does not include a common or contract carrier, public 27
warehouseperson, or employee of the carrier or warehouseperson.28
(3) "Board" means the Washington state liquor and cannabis board.29
(4) "Cannabis" means all parts of the plant Cannabis, whether 30
growing or not, with a THC concentration greater than 0.3 percent on 31
a dry weight basis during the growing cycle through harvest and 32
usable cannabis. "Cannabis" does not include hemp or industrial hemp 33
as defined in RCW 15.140.020, or seeds used for licensed hemp 34
production under chapter 15.140 RCW. 35
(5) "Cannabis concentrates" means products consisting wholly or 36
in part of the resin extracted from any part of the plant Cannabis 37
and having a THC concentration greater than ten percent.38
p. 111 HB 2127
(6) "Cannabis processor" means a person licensed by the board to 1
process cannabis into cannabis concentrates, useable cannabis, and 2
cannabis-infused products, package and label cannabis concentrates, 3
useable cannabis, and cannabis-infused products for sale in retail 4
outlets, and sell cannabis concentrates, useable cannabis, and 5
cannabis-infused products at wholesale to cannabis retailers.6
(7) "Cannabis producer" means a person licensed by the board to 7
produce and sell cannabis at wholesale to cannabis processors and 8
other cannabis producers. 9
(8)(a) "Cannabis products" means useable cannabis, cannabis 10
concentrates, and cannabis-infused products as defined in this 11
section, including any product intended to be consumed or absorbed 12
inside the body by any means including inhalation, ingestion, or 13
insertion, with any detectable amount of THC. 14
(b) "Cannabis products" also means any product containing only 15
THC content. 16
(c) "Cannabis products" does not include cannabis health and 17
beauty aids as defined in RCW 69.50.575 or products approved by the 18
United States food and drug administration. 19
(9) "Cannabis researcher" means a person licensed by the board to 20
produce, process, and possess cannabis for the purposes of conducting 21
research on cannabis and cannabis-derived drug products.22
(10) "Cannabis retailer" means a person licensed by the board to 23
sell cannabis concentrates, useable cannabis, and cannabis-infused 24
products in a retail outlet. 25
(11) "Cannabis-infused products" means products that contain 26
cannabis or cannabis extracts, are intended for human use, are 27
derived from cannabis as defined in subsection (4) of this section, 28
and have a THC concentration no greater than ten percent. The term 29
"cannabis-infused products" does not include either useable cannabis 30
or cannabis concentrates. 31
(12) "CBD concentration" has the meaning provided in RCW 32
69.51A.010. 33
(13) "CBD product" means any product containing or consisting of 34
cannabidiol. 35
(14) "Commission" means the pharmacy quality assurance 36
commission. 37
(15) "Controlled substance" means a drug, substance, or immediate 38
precursor included in Schedules I through V as set forth in federal 39
p. 112 HB 2127
or state laws, or federal or commission rules, but does not include 1
hemp or industrial hemp as defined in RCW 15.140.020.2
(16)(a) "Controlled substance analog" means a substance the 3
chemical structure of which is substantially similar to the chemical 4
structure of a controlled substance in Schedule I or II and:5
(i) that has a stimulant, depressant, or hallucinogenic effect on 6
the central nervous system substantially similar to the stimulant, 7
depressant, or hallucinogenic effect on the central nervous system of 8
a controlled substance included in Schedule I or II; or9
(ii) with respect to a particular individual, that the individual 10
represents or intends to have a stimulant, depressant, or 11
hallucinogenic effect on the central nervous system substantially 12
similar to the stimulant, depressant, or hallucinogenic effect on the 13
central nervous system of a controlled substance included in Schedule 14
I or II. 15
(b) The term does not include: 16
(i) a controlled substance; 17
(ii) a substance for which there is an approved new drug 18
application; 19
(iii) a substance with respect to which an exemption is in effect 20
for investigational use by a particular person under Section 505 of 21
the federal food, drug, and cosmetic act, 21 U.S.C. Sec. 355, or 22
chapter 69.77 RCW to the extent conduct with respect to the substance 23
is pursuant to the exemption; or 24
(iv) any substance to the extent not intended for human 25
consumption before an exemption takes effect with respect to the 26
substance. 27
(17) "Deliver" or "delivery" means the actual or constructive 28
transfer from one person to another of a substance, whether or not 29
there is an agency relationship. 30
(18) "Department" means the department of health.31
(19) "Designated provider" has the meaning provided in RCW 32
69.51A.010. 33
(20) "Dispense" means the interpretation of a prescription or 34
order for a controlled substance and, pursuant to that prescription 35
or order, the proper selection, measuring, compounding, labeling, or 36
packaging necessary to prepare that prescription or order for 37
delivery. 38
(21) "Dispenser" means a practitioner who dispenses.39
p. 113 HB 2127
(22) "Distribute" means to deliver other than by administering or 1
dispensing a controlled substance. 2
(23) "Distributor" means a person who distributes.3
(24) "Drug" means (a) a controlled substance recognized as a drug 4
in the official United States pharmacopoeia/national formulary or the 5
official homeopathic pharmacopoeia of the United States, or any 6
supplement to them; (b) controlled substances intended for use in the 7
diagnosis, cure, mitigation, treatment, or prevention of disease in 8
individuals or animals; (c) controlled substances (other than food) 9
intended to affect the structure or any function of the body of 10
individuals or animals; and (d) controlled substances intended for 11
use as a component of any article specified in (a), (b), or (c) of 12
this subsection. The term does not include devices or their 13
components, parts, or accessories. 14
(25) "Drug enforcement administration" means the drug enforcement 15
administration in the United States Department of Justice, or its 16
successor agency. 17
(26) "Electronic communication of prescription information" means 18
the transmission of a prescription or refill authorization for a drug 19
of a practitioner using computer systems. The term does not include a 20
prescription or refill authorization verbally transmitted by 21
telephone nor a facsimile manually signed by the practitioner.22
(27) "Immature plant or clone" means a plant or clone that has no 23
flowers, is less than twelve inches in height, and is less than 24
twelve inches in diameter. 25
(28) "Immediate precursor" means a substance: 26
(a) that the commission has found to be and by rule designates as 27
being the principal compound commonly used, or produced primarily for 28
use, in the manufacture of a controlled substance;29
(b) that is an immediate chemical intermediary used or likely to 30
be used in the manufacture of a controlled substance; and31
(c) the control of which is necessary to prevent, curtail, or 32
limit the manufacture of the controlled substance.33
(29) "Isomer" means an optical isomer, but in subsection (33)(e) 34
of this section, RCW 69.50.204(1) (l) and (hh), and 69.50.206(2)(d), 35
the term includes any geometrical isomer; in RCW 69.50.204(1) (h) and 36
(pp) and 69.50.210(3), the term includes any positional isomer; and 37
in RCW 69.50.204(1)(ii), 69.50.204(3), and 69.50.208(1), the term 38
includes any positional or geometric isomer. 39
p. 114 HB 2127
(30) "Lot" means a definite quantity of cannabis, cannabis 1
concentrates, useable cannabis, or cannabis-infused product 2
identified by a lot number, every portion or package of which is 3
uniform within recognized tolerances for the factors that appear in 4
the labeling. 5
(31) "Lot number" must identify the licensee by business or trade 6
name and Washington state unified business identifier number, and the 7
date of harvest or processing for each lot of cannabis, cannabis 8
concentrates, useable cannabis, or cannabis-infused product.9
(32) "Manufacture" means the production, preparation, 10
propagation, compounding, conversion, or processing of a controlled 11
substance, either directly or indirectly or by extraction from 12
substances of natural origin, or independently by means of chemical 13
synthesis, or by a combination of extraction and chemical synthesis, 14
and includes any packaging or repackaging of the substance or 15
labeling or relabeling of its container. The term does not include 16
the preparation, compounding, packaging, repackaging, labeling, or 17
relabeling of a controlled substance: 18
(a) by a practitioner as an incident to the practitioner's 19
administering or dispensing of a controlled substance in the course 20
of the practitioner's professional practice; or 21
(b) by a practitioner, or by the practitioner's authorized agent 22
under the practitioner's supervision, for the purpose of, or as an 23
incident to, research, teaching, or chemical analysis and not for 24
sale. 25
(33) "Narcotic drug" means any of the following, whether produced 26
directly or indirectly by extraction from substances of vegetable 27
origin, or independently by means of chemical synthesis, or by a 28
combination of extraction and chemical synthesis: 29
(a) Opium, opium derivative, and any derivative of opium or opium 30
derivative, including their salts, isomers, and salts of isomers, 31
whenever the existence of the salts, isomers, and salts of isomers is 32
possible within the specific chemical designation. The term does not 33
include the isoquinoline alkaloids of opium. 34
(b) Synthetic opiate and any derivative of synthetic opiate, 35
including their isomers, esters, ethers, salts, and salts of isomers, 36
esters, and ethers, whenever the existence of the isomers, esters, 37
ethers, and salts is possible within the specific chemical 38
designation. 39
(c) Poppy straw and concentrate of poppy straw.40
p. 115 HB 2127
(d) Coca leaves, except coca leaves and extracts of coca leaves 1
from which cocaine, ecgonine, and derivatives or ecgonine or their 2
salts have been removed. 3
(e) Cocaine, or any salt, isomer, or salt of isomer thereof.4
(f) Cocaine base. 5
(g) Ecgonine, or any derivative, salt, isomer, or salt of isomer 6
thereof. 7
(h) Any compound, mixture, or preparation containing any quantity 8
of any substance referred to in (a) through (g) of this subsection.9
(34) "Opiate" means any substance having an addiction-forming or 10
addiction-sustaining liability similar to morphine or being capable 11
of conversion into a drug having addiction-forming or addiction-12
sustaining liability. The term includes opium, substances derived 13
from opium (opium derivatives), and synthetic opiates. The term does 14
not include, unless specifically designated as controlled under RCW 15
69.50.201, the dextrorotatory isomer of 3-methoxy-n-methylmorphinan 16
and its salts (dextromethorphan). The term includes the racemic and 17
levorotatory forms of dextromethorphan. 18
(35) "Opium poppy" means the plant of the species Papaver 19
somniferum L., except its seeds. 20
(36) "Package" means a container that has a single unit or group 21
of units. 22
(37) "Person" means individual, corporation, business trust, 23
estate, trust, partnership, association, joint venture, government, 24
governmental subdivision or agency, or any other legal or commercial 25
entity. 26
(38) "Plant" has the meaning provided in RCW 69.51A.010.27
(39) "Poppy straw" means all parts, except the seeds, of the 28
opium poppy, after mowing. 29
(40) "Practitioner" means: 30
(a) A physician under chapter 18.71 RCW; a physician 31
((assistant)) associate under chapter 18.71A RCW; an osteopathic 32
physician and surgeon under chapter 18.57 RCW; an optometrist 33
licensed under chapter 18.53 RCW who is certified by the optometry 34
board under RCW 18.53.010 subject to any limitations in RCW 35
18.53.010; a dentist under chapter 18.32 RCW; a podiatric physician 36
and surgeon under chapter 18.22 RCW; a veterinarian under chapter 37
18.92 RCW; a registered nurse, advanced practice registered nurse, or 38
licensed practical nurse under chapter 18.79 RCW; a naturopathic 39
physician under chapter 18.36A RCW who is licensed under RCW 40
p. 116 HB 2127
18.36A.030 subject to any limitations in RCW 18.36A.040; a pharmacist 1
under chapter 18.64 RCW or a scientific investigator under this 2
chapter, licensed, registered or otherwise permitted insofar as is 3
consistent with those licensing laws to distribute, dispense, conduct 4
research with respect to or administer a controlled substance in the 5
course of their professional practice or research in this state.6
(b) A pharmacy, hospital or other institution licensed, 7
registered, or otherwise permitted to distribute, dispense, conduct 8
research with respect to or to administer a controlled substance in 9
the course of professional practice or research in this state.10
(c) A physician licensed to practice medicine and surgery, a 11
physician licensed to practice osteopathic medicine and surgery, a 12
dentist licensed to practice dentistry, a podiatric physician and 13
surgeon licensed to practice podiatric medicine and surgery, a 14
licensed physician ((assistant or a licensed osteopathic physician 15
assistant)) associate specifically approved to prescribe controlled 16
substances by his or her state's medical commission or equivalent and 17
his or her participating physician as defined in RCW 18.71A.010, an 18
advanced practice registered nurse licensed to prescribe controlled 19
substances, or a veterinarian licensed to practice veterinary 20
medicine in any state of the United States. 21
(41) "Prescription" means an order for controlled substances 22
issued by a practitioner duly authorized by law or rule in the state 23
of Washington to prescribe controlled substances within the scope of 24
his or her professional practice for a legitimate medical purpose.25
(42) "Production" includes the manufacturing, planting, 26
cultivating, growing, or harvesting of a controlled substance.27
(43) "Qualifying patient" has the meaning provided in RCW 28
69.51A.010. 29
(44) "Recognition card" has the meaning provided in RCW 30
69.51A.010. 31
(45) "Retail outlet" means a location licensed by the board for 32
the retail sale of cannabis concentrates, useable cannabis, and 33
cannabis-infused products. 34
(46) "Secretary" means the secretary of health or the secretary's 35
designee. 36
(47) "Social equity plan" means a plan that addresses at least 37
some of the elements outlined in this subsection (47), along with any 38
additional plan components or requirements approved by the board 39
p. 117 HB 2127
following consultation with the task force created in RCW 69.50.336. 1
The plan may include: 2
(a) A statement that indicates how the cannabis licensee will 3
work to promote social equity goals in their community;4
(b) A description of how the cannabis licensee will meet social 5
equity goals as defined in RCW 69.50.335; 6
(c) The composition of the workforce the licensee has employed or 7
intends to hire; and 8
(d) Business plans involving partnerships or assistance to 9
organizations or residents with connections to populations with a 10
history of high rates of enforcement of cannabis prohibition.11
(48) "State," unless the context otherwise requires, means a 12
state of the United States, the District of Columbia, the 13
Commonwealth of Puerto Rico, or a territory or insular possession 14
subject to the jurisdiction of the United States. 15
(49) "THC concentration" means percent of tetrahydrocannabinol 16
content of any part of the plant Cannabis, or per volume or weight of 17
cannabis product, or the combined percent of tetrahydrocannabinol and 18
tetrahydrocannabinolic acid in any part of the plant Cannabis 19
regardless of moisture content. 20
(50) "Ultimate user" means an individual who lawfully possesses a 21
controlled substance for the individual's own use or for the use of a 22
member of the individual's household or for administering to an 23
animal owned by the individual or by a member of the individual's 24
household. 25
(51) "Unit" means an individual consumable item within a package 26
of one or more consumable items in solid, liquid, gas, or any form 27
intended for human consumption. 28
(52) "Useable cannabis" means dried cannabis flowers. The term 29
"useable cannabis" does not include either cannabis-infused products 30
or cannabis concentrates. 31
(53) "Youth access" means the level of interest persons under the 32
age of twenty-one may have in a vapor product, as well as the degree 33
to which the product is available or appealing to such persons, and 34
the likelihood of initiation, use, or addiction by adolescents and 35
young adults. 36
Sec. 83. RCW 69.51A.010 and 2025 c 58 s 5127 are each amended to 37
read as follows: 38
p. 118 HB 2127
The definitions in this section apply throughout this chapter 1
unless the context clearly requires otherwise. 2
(1)(a) "Authorization" means a form developed by the department 3
that is completed and signed by a qualifying patient's health care 4
professional and printed on tamper-resistant paper.5
(b) An authorization is not a prescription as defined in RCW 6
69.50.101. 7
(2) "Cannabis" has the meaning provided in RCW 69.50.101.8
(3) "Cannabis concentrates" has the meaning provided in RCW 9
69.50.101. 10
(4) "Cannabis processor" has the meaning provided in RCW 11
69.50.101. 12
(5) "Cannabis producer" has the meaning provided in RCW 13
69.50.101. 14
(6) "Cannabis retailer" has the meaning provided in RCW 15
69.50.101. 16
(7) "Cannabis retailer with a medical cannabis endorsement" means 17
a cannabis retailer that has been issued a medical cannabis 18
endorsement by the state liquor and cannabis board pursuant to RCW 19
69.50.375. 20
(8) "Cannabis-infused products" has the meaning provided in RCW 21
69.50.101. 22
(9) "CBD concentration" means the percent of cannabidiol content 23
per dry weight of any part of the plant Cannabis, or per volume or 24
weight of cannabis product. 25
(10) "Department" means the department of health.26
(11) "Designated provider" means a person who is twenty-one years 27
of age or older and: 28
(a)(i) Is the parent or guardian of a qualifying patient who is 29
under the age of eighteen and holds a recognition card; or30
(ii) Has been designated in writing by a qualifying patient to 31
serve as the designated provider for that patient;32
(b)(i) Has an authorization from the qualifying patient's health 33
care professional; or 34
(ii)(A) Has been entered into the medical cannabis authorization 35
database as being the designated provider to a qualifying patient; 36
and 37
(B) Has been provided a recognition card; 38
p. 119 HB 2127
(c) Is prohibited from consuming cannabis obtained for the 1
personal, medical use of the qualifying patient for whom the 2
individual is acting as designated provider; 3
(d) Provides cannabis to only the qualifying patient that has 4
designated him or her; 5
(e) Is in compliance with the terms and conditions of this 6
chapter; and 7
(f) Is the designated provider to only one patient at any one 8
time. 9
(12) "Health care professional," for purposes of this chapter 10
only, means a physician licensed under chapter 18.71 RCW, a physician 11
((assistant)) associate licensed under chapter 18.71A RCW, an 12
osteopathic physician licensed under chapter 18.57 RCW, a naturopath 13
licensed under chapter 18.36A RCW, or an advanced practice registered 14
nurse licensed under chapter 18.79 RCW. 15
(13) "Housing unit" means a house, an apartment, a mobile home, a 16
group of rooms, or a single room that is occupied as separate living 17
quarters, in which the occupants live and eat separately from any 18
other persons in the building, and which have direct access from the 19
outside of the building or through a common hall. 20
(14) "Low THC, high CBD" means products determined by the 21
department to have a low THC, high CBD ratio under RCW 69.50.375. Low 22
THC, high CBD products must be inhalable, ingestible, or absorbable.23
(15) "Medical cannabis authorization database" means the secure 24
and confidential database established in RCW 69.51A.230.25
(16) "Medical use of cannabis" means the manufacture, production, 26
possession, transportation, delivery, ingestion, application, or 27
administration of cannabis for the exclusive benefit of a qualifying 28
patient in the treatment of his or her terminal or debilitating 29
medical condition. 30
(17) "Plant" means a cannabis plant having at least three 31
distinguishable and distinct leaves, each leaf being at least three 32
centimeters in diameter, and a readily observable root formation 33
consisting of at least two separate and distinct roots, each being at 34
least two centimeters in length. Multiple stalks emanating from the 35
same root ball or root system is considered part of the same single 36
plant. 37
(18) "Public place" has the meaning provided in RCW 70.160.020.38
(19) "Qualifying patient" means a person who: 39
(a)(i) Is a patient of a health care professional;40
p. 120 HB 2127
(ii) Has been diagnosed by that health care professional as 1
having a terminal or debilitating medical condition;2
(iii) Is a resident of the state of Washington at the time of 3
such diagnosis; 4
(iv) Has been advised by that health care professional about the 5
risks and benefits of the medical use of cannabis; 6
(v) Has been advised by that health care professional that they 7
may benefit from the medical use of cannabis; 8
(vi)(A) Has an authorization from his or her health care 9
professional; or 10
(B) Has been entered into the medical cannabis authorization 11
database and has been provided a recognition card; and12
(vii) Is otherwise in compliance with the terms and conditions 13
established in this chapter. 14
(b) "Qualifying patient" does not include a person who is 15
actively being supervised for a criminal conviction by a corrections 16
agency or department that has determined that the terms of this 17
chapter are inconsistent with and contrary to his or her supervision 18
and all related processes and procedures related to that supervision.19
(20) "Recognition card" means a card issued to qualifying 20
patients and designated providers by a cannabis retailer with a 21
medical cannabis endorsement that has entered them into the medical 22
cannabis authorization database. 23
(21) "Retail outlet" has the meaning provided in RCW 69.50.101.24
(22) "Secretary" means the secretary of the department of health.25
(23) "Tamper-resistant paper" means paper that meets one or more 26
of the following industry-recognized features: 27
(a) One or more features designed to prevent copying of the 28
paper; 29
(b) One or more features designed to prevent the erasure or 30
modification of information on the paper; or 31
(c) One or more features designed to prevent the use of 32
counterfeit authorization. 33
(24) "Terminal or debilitating medical condition" means a 34
condition severe enough to significantly interfere with the patient's 35
activities of daily living and ability to function, which can be 36
objectively assessed and evaluated and limited to the following:37
(a) Cancer, human immunodeficiency virus (HIV), multiple 38
sclerosis, epilepsy or other seizure disorder, or spasticity 39
disorders; 40
p. 121 HB 2127
(b) Intractable pain, limited for the purpose of this chapter to 1
mean pain unrelieved by standard medical treatments and medications;2
(c) Glaucoma, either acute or chronic, limited for the purpose of 3
this chapter to mean increased intraocular pressure unrelieved by 4
standard treatments and medications; 5
(d) Crohn's disease with debilitating symptoms unrelieved by 6
standard treatments or medications; 7
(e) Hepatitis C with debilitating nausea or intractable pain 8
unrelieved by standard treatments or medications; 9
(f) Diseases, including anorexia, which result in nausea, 10
vomiting, wasting, appetite loss, cramping, seizures, muscle spasms, 11
or spasticity, when these symptoms are unrelieved by standard 12
treatments or medications; 13
(g) Posttraumatic stress disorder; or 14
(h) Traumatic brain injury. 15
(25) "THC concentration" has the meaning provided in RCW 16
69.50.101. 17
(26) "Useable cannabis" has the meaning provided in RCW 18
69.50.101. 19
Sec. 84. RCW 70.05.030 and 2025 c 260 s 1 are each amended to 20
read as follows: 21
(1) Except as provided in subsection (2) of this section, for 22
counties without a home rule charter, the board of county 23
commissioners and the members selected under (a) and (e) of this 24
subsection, shall constitute the local board of health, unless the 25
county is part of a health district pursuant to chapter 70.46 RCW. 26
For counties without a home rule charter where the board of county 27
commissioners is comprised of five commissioners, the board of county 28
commissioners may adopt an ordinance reducing the number of county 29
commissioners that are members of the local board of health, provided 30
that the board of health includes at least one county commissioner. 31
The jurisdiction of the local board of health shall be coextensive 32
with the boundaries of the county. 33
(a) The remaining board members must be persons who are not 34
elected officials and must be selected from the following categories 35
consistent with the requirements of this section and the rules 36
adopted by the state board of health under RCW 43.20.300:37
p. 122 HB 2127
(i) Public health, health care facilities, and providers. This 1
category consists of persons practicing or employed in the county who 2
are: 3
(A) Medical ethicists; 4
(B) Epidemiologists; 5
(C) Experienced in environmental public health, such as a 6
registered sanitarian; 7
(D) Community health workers; 8
(E) Holders of master's degrees or higher in public health or the 9
equivalent; 10
(F) Employees of a hospital located in the county; or11
(G) Any of the following providers holding an active or retired 12
license in good standing under Title 18 RCW: 13
(I) Physicians or osteopathic physicians; 14
(II) Advanced practice registered nurses; 15
(III) Physician ((assistants or osteopathic physician 16
assistants)) associates; 17
(IV) Registered nurses; 18
(V) Dentists; 19
(VI) Naturopaths; or 20
(VII) Pharmacists; 21
(ii) Consumers of public health. This category consists of county 22
residents who have self-identified as having faced significant health 23
inequities or as having lived experiences with public health-related 24
programs such as: The special supplemental nutrition program for 25
women, infants, and children; the supplemental nutrition program; 26
home visiting; or treatment services. It is strongly encouraged that 27
individuals from historically marginalized and underrepresented 28
communities are given preference. These individuals may not be 29
elected officials and may not have any fiduciary obligation to a 30
health facility or other health agency, and may not have a material 31
financial interest in the rendering of health services; and32
(iii) Other community stakeholders. This category consists of 33
persons representing the following types of organizations located in 34
the county: 35
(A) Community-based organizations or nonprofits that work with 36
populations experiencing health inequities in the county;37
(B) Active, reserve, or retired armed services members;38
(C) The business community; or 39
(D) The environmental public health regulated community.40
p. 123 HB 2127
(b) The board members selected under (a) of this subsection must 1
be approved by a majority vote of the board of county commissioners.2
(c) If the number of board members selected under (a) of this 3
subsection is evenly divisible by three, there must be an equal 4
number of members selected from each of the three categories. If 5
there are one or two members over the nearest multiple of three, 6
those members may be selected from any of the three categories. 7
However, if the board of health demonstrates that it attempted to 8
recruit members from all three categories and was unable to do so, 9
the board may select members only from the other two categories.10
(d) There may be no more than one member selected under (a) of 11
this subsection from one type of background or position.12
(e) If a federally recognized Indian tribe holds reservation or 13
trust lands within the county, or if an urban Indian organization 14
recognized by the Indian health service and registered as a 501 (c)(3) 15
organization in Washington that serves American Indian and Alaska 16
Native people provides services within the county, the board of 17
health must allow a tribal representative from each tribe and each 18
organization, as selected by such tribe or organization, to serve as 19
a member and must notify the American Indian health commission.20
(f) The board of county commissioners may, at its discretion, 21
adopt an ordinance expanding the size and composition of the board of 22
health to include elected officials from cities and towns and persons 23
other than elected officials as members so long as the city and 24
county elected officials do not constitute a majority of the total 25
membership of the board. 26
(g) Except as provided in (a) and (e) of this subsection, an 27
ordinance adopted under this section shall include provisions for the 28
appointment, term, and compensation, or reimbursement of expenses.29
(h) The jurisdiction of the local board of health shall be 30
coextensive with the boundaries of the county. 31
(i) The local health officer, as described in RCW 70.05.050, 32
shall be appointed by the official designated under the provisions of 33
the county charter. The same official designated under the provisions 34
of the county charter may appoint an administrative officer, as 35
described in RCW 70.05.045. 36
(j) The number of members selected or included under (a) and (e) 37
of this subsection must equal the number of city and county elected 38
officials on the board of health. If a member is added under (e) of 39
p. 124 HB 2127
this subsection, the board of county commissioners shall modify the 1
membership of the board: 2
(i) In compliance with timelines established by the state board 3
of health in rule once such rules are in effect; and4
(ii) Until the rules in (j)(i) of this subsection are in effect, 5
within 60 days of receipt of notice of the selection of a tribal 6
representative. 7
(k) At the first meeting of a district board of health the 8
members shall elect a chair to serve for a period of one year.9
(l) Any decision by the board of health related to the setting or 10
modification of permit, licensing, and application fees may only be 11
determined by the city and county elected officials on the board.12
(2) A local board of health comprised solely of elected officials 13
may retain this composition if the local health jurisdiction had a 14
public health advisory committee or board with its own bylaws 15
established on January 1, 2021. By January 1, 2022, the public health 16
advisory committee or board must meet the requirements established in 17
RCW 70.46.140 for community health advisory boards. Any future 18
changes to local board of health composition must meet the 19
requirements of subsection (1) of this section. 20
Sec. 85. RCW 70.05.035 and 2025 c 260 s 2 are each amended to 21
read as follows: 22
(1) Except as provided in subsection (2) of this section, for 23
home rule charter counties, the county legislative authority shall 24
establish a local board of health and may prescribe the membership 25
and selection process for the board. The membership of the local 26
board of health must also include the members selected under (a) and 27
(e) of this subsection. 28
(a) The remaining board members must be persons who are not 29
elected officials and must be selected from the following categories 30
consistent with the requirements of this section and the rules 31
adopted by the state board of health under RCW 43.20.300:32
(i) Public health, health care facilities, and providers. This 33
category consists of persons practicing or employed in the county who 34
are: 35
(A) Medical ethicists; 36
(B) Epidemiologists; 37
(C) Experienced in environmental public health, such as a 38
registered sanitarian; 39
p. 125 HB 2127
(D) Community health workers; 1
(E) Holders of master's degrees or higher in public health or the 2
equivalent; 3
(F) Employees of a hospital located in the county; or4
(G) Any of the following providers holding an active or retired 5
license in good standing under Title 18 RCW: 6
(I) Physicians or osteopathic physicians; 7
(II) Advanced practice registered nurses; 8
(III) Physician ((assistants or osteopathic physician 9
assistants)) associates; 10
(IV) Registered nurses; 11
(V) Dentists; 12
(VI) Naturopaths; or 13
(VII) Pharmacists; 14
(ii) Consumers of public health. This category consists of county 15
residents who have self-identified as having faced significant health 16
inequities or as having lived experiences with public health-related 17
programs such as: The special supplemental nutrition program for 18
women, infants, and children; the supplemental nutrition program; 19
home visiting; or treatment services. It is strongly encouraged that 20
individuals from historically marginalized and underrepresented 21
communities are given preference. These individuals may not be 22
elected officials and may not have any fiduciary obligation to a 23
health facility or other health agency, and may not have a material 24
financial interest in the rendering of health services; and25
(iii) Other community stakeholders. This category consists of 26
persons representing the following types of organizations located in 27
the county: 28
(A) Community-based organizations or nonprofits that work with 29
populations experiencing health inequities in the county;30
(B) Active, reserve, or retired armed services members;31
(C) The business community; or 32
(D) The environmental public health regulated community.33
(b) The board members selected under (a) of this subsection must 34
be approved by a majority vote of the board of county commissioners.35
(c) If the number of board members selected under (a) of this 36
subsection is evenly divisible by three, there must be an equal 37
number of members selected from each of the three categories. If 38
there are one or two members over the nearest multiple of three, 39
those members may be selected from any of the three categories. 40
p. 126 HB 2127
However, if the board of health demonstrates that it attempted to 1
recruit members from all three categories and was unable to do so, 2
the board may select members only from the other two categories.3
(d) There may be no more than one member selected under (a) of 4
this subsection from one type of background or position.5
(e) If a federally recognized Indian tribe holds reservation or 6
trust lands within the county, or if an urban Indian organization 7
recognized by the Indian health service and registered as a 501 (c)(3) 8
organization in Washington that serves American Indian and Alaska 9
Native people provides services within the county, the board of 10
health must allow a tribal representative from each tribe and each 11
organization, as selected by such tribe or organization, to serve as 12
a member and must notify the American Indian health commission.13
(f) The county legislative authority may appoint to the board of 14
health elected officials from cities and towns and persons other than 15
elected officials as members so long as the city and county elected 16
officials do not constitute a majority of the total membership of the 17
board. 18
(g) Except as provided in (a) and (e) of this subsection, the 19
county legislative authority shall specify the appointment, term, and 20
compensation or reimbursement of expenses. 21
(h) The jurisdiction of the local board of health shall be 22
coextensive with the boundaries of the county. 23
(i) The local health officer, as described in RCW 70.05.050, 24
shall be appointed by the official designated under the provisions of 25
the county charter. The same official designated under the provisions 26
of the county charter may appoint an administrative officer, as 27
described in RCW 70.05.045. 28
(j) The number of members selected or included under (a) and (e) 29
of this subsection must equal the number of city and county elected 30
officials on the board of health. If a member is added under (e) of 31
this subsection, the county legislative authority shall modify the 32
membership of the board: 33
(i) In compliance with timelines established by the state board 34
of health in rule once such rules are in effect; and35
(ii) Until the rules in (j)(i) of this subsection are in effect, 36
within 60 days of receipt of notice of the selection of a tribal 37
representative. 38
(k) At the first meeting of a district board of health the 39
members shall elect a chair to serve for a period of one year.40
p. 127 HB 2127
(l) Any decision by the board of health related to the setting or 1
modification of permit, licensing, and application fees may only be 2
determined by the city and county elected officials on the board.3
(2) A local board of health comprised solely of elected officials 4
may retain this composition if the local health jurisdiction had a 5
public health advisory committee or board with its own bylaws 6
established on January 1, 2021. By January 1, 2022, the public health 7
advisory committee or board must meet the requirements established in 8
RCW 70.46.140 for community health advisory boards. Any future 9
changes to local board of health composition must meet the 10
requirements of subsection (1) of this section. 11
Sec. 86. RCW 70.30.061 and 2025 c 58 s 5131 are each amended to 12
read as follows: 13
Any person residing in the state and needing treatment for 14
tuberculosis may apply in person to the local health officer or to 15
any licensed physician, advanced practice registered nurse, or 16
licensed physician ((assistant)) associate for examination and if 17
that health care provider has reasonable cause to believe that the 18
person is suffering from tuberculosis in any form he or she may apply 19
to the local health officer or designee for admission of the person 20
to an appropriate facility for the care and treatment of 21
tuberculosis. 22
Sec. 87. RCW 70.41.210 and 2020 c 80 s 45 are each amended to 23
read as follows: 24
(1) The chief administrator or executive officer of a hospital 25
shall report to the department when the practice of a health care 26
practitioner as defined in subsection (2) of this section is 27
restricted, suspended, limited, or terminated based upon a 28
conviction, determination, or finding by the hospital that the health 29
care practitioner has committed an action defined as unprofessional 30
conduct under RCW 18.130.180. The chief administrator or executive 31
officer shall also report any voluntary restriction or termination of 32
the practice of a health care practitioner as defined in subsection 33
(2) of this section while the practitioner is under investigation or 34
the subject of a proceeding by the hospital regarding unprofessional 35
conduct, or in return for the hospital not conducting such an 36
investigation or proceeding or not taking action. The department will 37
forward the report to the appropriate disciplining authority.38
p. 128 HB 2127
(2) The reporting requirements apply to the following health care 1
practitioners: Pharmacists as defined in chapter 18.64 RCW; advanced 2
practice registered nurse s ((practitioners)) as defined in chapter 3
18.79 RCW; dentists as defined in chapter 18.32 RCW; naturopaths as 4
defined in chapter 18.36A RCW; optometrists as defined in chapter 5
18.53 RCW; osteopathic physicians and surgeons as defined in chapter 6
18.57 RCW; physicians as defined in chapter 18.71 RCW; physician 7
((assistants)) associates as defined in chapter 18.71A RCW; podiatric 8
physicians and surgeons as defined in chapter 18.22 RCW; and 9
psychologists as defined in chapter 18.83 RCW. 10
(3) Reports made under subsection (1) of this section shall be 11
made within fifteen days of the date: (a) A conviction, 12
determination, or finding is made by the hospital that the health 13
care practitioner has committed an action defined as unprofessional 14
conduct under RCW 18.130.180; or (b) the voluntary restriction or 15
termination of the practice of a health care practitioner, including 16
his or her voluntary resignation, while under investigation or the 17
subject of proceedings regarding unprofessional conduct under RCW 18
18.130.180 is accepted by the hospital. 19
(4) Failure of a hospital to comply with this section is 20
punishable by a civil penalty not to exceed five hundred dollars.21
(5) A hospital, its chief administrator, or its executive officer 22
who files a report under this section is immune from suit, whether 23
direct or derivative, in any civil action related to the filing or 24
contents of the report, unless the conviction, determination, or 25
finding on which the report and its content are based is proven to 26
not have been made in good faith. The prevailing party in any action 27
brought alleging the conviction, determination, finding, or report 28
was not made in good faith, shall be entitled to recover the costs of 29
litigation, including reasonable attorneys' fees. 30
(6) The department shall forward reports made under subsection 31
(1) of this section to the appropriate disciplining authority 32
designated under Title 18 RCW within fifteen days of the date the 33
report is received by the department. The department shall notify a 34
hospital that has made a report under subsection (1) of this section 35
of the results of the disciplining authority's case disposition 36
decision within fifteen days after the case disposition. Case 37
disposition is the decision whether to issue a statement of charges, 38
take informal action, or close the complaint without action against a 39
practitioner. In its biennial report to the legislature under RCW 40
p. 129 HB 2127
18.130.310, the department shall specifically identify the case 1
dispositions of reports made by hospitals under subsection (1) of 2
this section. 3
(7) The department shall not increase hospital license fees to 4
carry out this section before July 1, 2008. 5
Sec. 88. RCW 70.41.230 and 2025 c 58 s 5132 are each amended to 6
read as follows: 7
(1) Except as provided in subsection (3) of this section, prior 8
to granting or renewing clinical privileges or association of any 9
physician, physician ((assistant)) associate, or advanced practice 10
registered nurse or hiring a physician, physician ((assistant)) 11
associate, or advanced practice registered nurse who will provide 12
clinical care under his or her license, a hospital or facility 13
approved pursuant to this chapter shall request from the physician, 14
physician ((assistant)) associate, or advanced practice registered 15
nurse and the physician, physician ((assistant)) associate, or 16
advanced practice registered nurse shall provide the following 17
information: 18
(a) The name of any hospital or facility with or at which the 19
physician, physician ((assistant)) associate, or advanced practice 20
registered nurse had or has any association, employment, privileges, 21
or practice during the prior five years: PROVIDED, That the hospital 22
may request additional information going back further than five 23
years, and the physician, physician ((assistant)) associate, or 24
advanced practice registered nurse shall use his or her best efforts 25
to comply with such a request for additional information;26
(b) Whether the physician, physician ((assistant)) associate, or 27
advanced practice registered nurse has ever been or is in the process 28
of being denied, revoked, terminated, suspended, restricted, reduced, 29
limited, sanctioned, placed on probation, monitored, or not renewed 30
for any professional activity listed in (b)(i) through (x) of this 31
subsection, or has ever voluntarily or involuntarily relinquished, 32
withdrawn, or failed to proceed with an application for any 33
professional activity listed in (b)(i) through (x) of this subsection 34
in order to avoid an adverse action or to preclude an investigation 35
or while under investigation relating to professional competence or 36
conduct: 37
(i) License to practice any profession in any jurisdiction;38
p. 130 HB 2127
(ii) Other professional registration or certification in any 1
jurisdiction; 2
(iii) Specialty or subspecialty board certification;3
(iv) Membership on any hospital medical staff; 4
(v) Clinical privileges at any facility, including hospitals, 5
ambulatory surgical centers, or skilled nursing facilities;6
(vi) Medicare, medicaid, the food and drug administration, the 7
national institutes of health (office of human research protection), 8
governmental, national, or international regulatory agency, or any 9
public program; 10
(vii) Professional society membership or fellowship;11
(viii) Participation or membership in a health maintenance 12
organization, preferred provider organization, independent practice 13
association, physician-hospital organization, or other entity;14
(ix) Academic appointment; 15
(x) Authority to prescribe controlled substances (drug 16
enforcement agency or other authority); 17
(c) Any pending professional medical misconduct proceedings or 18
any pending medical malpractice actions in this state or another 19
state, the substance of the allegations in the proceedings or 20
actions, and any additional information concerning the proceedings or 21
actions as the physician, physician ((assistant)) associate, or 22
advanced practice registered nurse deems appropriate;23
(d) The substance of the findings in the actions or proceedings 24
and any additional information concerning the actions or proceedings 25
as the physician, physician ((assistant)) associate, or advanced 26
practice registered nurse deems appropriate; 27
(e) A waiver by the physician, physician ((assistant)) associate, 28
or advanced practice registered nurse of any confidentiality 29
provisions concerning the information required to be provided to 30
hospitals pursuant to this subsection; and 31
(f) A verification by the physician, physician ((assistant)) 32
associate, or advanced practice registered nurse that the information 33
provided by the physician, physician ((assistant)) associate, or 34
advanced practice registered nurse is accurate and complete.35
(2) Except as provided in subsection (3) of this section, prior 36
to granting privileges or association to any physician, physician 37
((assistant)) associate, or advanced practice registered nurse or 38
hiring a physician, physician ((assistant)) associate, or advanced 39
practice registered nurse who will provide clinical care under his or 40
p. 131 HB 2127
her license, a hospital or facility approved pursuant to this chapter 1
shall request from any hospital with or at which the physician, 2
physician ((assistant)) associate, or advanced practice registered 3
nurse had or has privileges, was associated, or was employed, during 4
the preceding five years, the following information concerning the 5
physician, physician ((assistant)) associate, or advanced practice 6
registered nurse: 7
(a) Any pending professional medical misconduct proceedings or 8
any pending medical malpractice actions, in this state or another 9
state; 10
(b) Any judgment or settlement of a medical malpractice action 11
and any finding of professional misconduct in this state or another 12
state by a licensing or disciplinary board; and 13
(c) Any information required to be reported by hospitals pursuant 14
to RCW 18.71.0195. 15
(3) In lieu of the requirements of subsections (1) and (2) of 16
this section, when granting or renewing credentials and privileges or 17
association of any physician, physician ((assistant)) associate, or 18
advanced practice registered nurse providing telemedicine or store 19
and forward services, an originating site hospital may rely on a 20
distant site hospital's decision to grant or renew credentials and 21
clinical privileges or association of the physician, physician 22
((assistant)) associate, or advanced practice registered nurse if the 23
originating site hospital obtains reasonable assurances, through a 24
written agreement with the distant site hospital, that all of the 25
following provisions are met: 26
(a) The distant site hospital providing the telemedicine or store 27
and forward services is a medicare participating hospital;28
(b) Any physician, physician ((assistant)) associate, or advanced 29
practice registered nurse providing telemedicine or store and forward 30
services at the distant site hospital will be fully credentialed and 31
privileged to provide such services by the distant site hospital;32
(c) Any physician, physician ((assistant)) associate, or advanced 33
practice registered nurse providing telemedicine or store and forward 34
services will hold and maintain a valid license to perform such 35
services issued or recognized by the state of Washington; and36
(d) With respect to any distant site physician, physician 37
((assistant)) associate, or advanced practice registered nurse who 38
holds current credentials and privileges at the originating site 39
hospital whose patients are receiving the telemedicine or store and 40
p. 132 HB 2127
forward services, the originating site hospital has evidence of an 1
internal review of the distant site physician's, physician 2
((assistant's)) associate's, or advanced practice registered nurse's 3
performance of these credentials and privileges and sends the distant 4
site hospital such performance information for use in the periodic 5
appraisal of the distant site physician, physician ((assistant)) 6
associate, or advanced practice registered nurse. At a minimum, this 7
information must include all adverse events, as defined in RCW 8
70.56.010, that result from the telemedicine or store and forward 9
services provided by the distant site physician, physician 10
((assistant)) associate, or advanced practice registered nurse to the 11
originating site hospital's patients and all complaints the 12
originating site hospital has received about the distant site 13
physician, physician ((assistant)) associate, or advanced practice 14
registered nurse. 15
(4)(a) The Washington medical commission or the board of 16
osteopathic medicine and surgery shall be advised within thirty days 17
of the name of any physician or physician ((assistant)) associate 18
denied staff privileges, association, or employment on the basis of 19
adverse findings under subsection (1) of this section.20
(b) The state board of nursing shall be advised within thirty 21
days of the name of any advanced practice registered nurse denied 22
staff privileges, association, or employment on the basis of adverse 23
findings under subsection (1) of this section. 24
(5) A hospital or facility that receives a request for 25
information from another hospital or facility pursuant to subsections 26
(1) through (3) of this section shall provide such information 27
concerning the physician, physician ((assistant)) associate, or 28
advanced practice registered nurse in question to the extent such 29
information is known to the hospital or facility receiving such a 30
request, including the reasons for suspension, termination, or 31
curtailment of employment or privileges at the hospital or facility. 32
A hospital, facility, or other person providing such information in 33
good faith is not liable in any civil action for the release of such 34
information. 35
(6) Information and documents, including complaints and incident 36
reports, created specifically for, and collected, and maintained by a 37
quality improvement committee are not subject to discovery or 38
introduction into evidence in any civil action, and no person who was 39
in attendance at a meeting of such committee or who participated in 40
p. 133 HB 2127
the creation, collection, or maintenance of information or documents 1
specifically for the committee shall be permitted or required to 2
testify in any civil action as to the content of such proceedings or 3
the documents and information prepared specifically for the 4
committee. This subsection does not preclude: (a) In any civil 5
action, the discovery of the identity of persons involved in the 6
medical care that is the basis of the civil action whose involvement 7
was independent of any quality improvement activity; (b) in any civil 8
action, the testimony of any person concerning the facts which form 9
the basis for the institution of such proceedings of which the person 10
had personal knowledge acquired independently of such proceedings; 11
(c) in any civil action by a health care provider regarding the 12
restriction or revocation of that individual's clinical or staff 13
privileges, introduction into evidence information collected and 14
maintained by quality improvement committees regarding such health 15
care provider; (d) in any civil action, disclosure of the fact that 16
staff privileges were terminated or restricted, including the 17
specific restrictions imposed, if any and the reasons for the 18
restrictions; or (e) in any civil action, discovery and introduction 19
into evidence of the patient's medical records required by regulation 20
of the department of health to be made regarding the care and 21
treatment received. 22
(7) Hospitals shall be granted access to information held by the 23
Washington medical commission, the board of osteopathic medicine and 24
surgery, and the state board of nursing pertinent to decisions of the 25
hospital regarding credentialing and recredentialing of 26
practitioners. 27
(8) Violation of this section shall not be considered negligence 28
per se. 29
Sec. 89. RCW 70.46.020 and 2025 c 260 s 3 are each amended to 30
read as follows: 31
(1) Except as provided in subsections (2) and (3) of this 32
section, health districts consisting of two or more counties may be 33
created whenever two or more boards of county commissioners shall by 34
resolution establish a district for such purpose. Such a district 35
shall consist of all the area of the combined counties. The district 36
board of health of such a district shall consist of not less than 37
five members for districts of two counties and seven members for 38
districts of more than two counties, including two representatives 39
p. 134 HB 2127
from each county who are members of the board of county commissioners 1
and who are appointed by the board of county commissioners of each 2
county within the district, and members selected under (a) and (e) of 3
this subsection, and shall have a jurisdiction coextensive with the 4
combined boundaries. 5
(a) The remaining board members must be persons who are not 6
elected officials and must be selected from the following categories 7
consistent with the requirements of this section and the rules 8
adopted by the state board of health under RCW 43.20.300:9
(i) Public health, health care facilities, and providers. This 10
category consists of persons practicing or employed in the health 11
district who are: 12
(A) Medical ethicists; 13
(B) Epidemiologists; 14
(C) Experienced in environmental public health, such as a 15
registered sanitarian; 16
(D) Community health workers; 17
(E) Holders of master's degrees or higher in public health or the 18
equivalent; 19
(F) Employees of a hospital located in the health district; or20
(G) Any of the following providers holding an active or retired 21
license in good standing under Title 18 RCW: 22
(I) Physicians or osteopathic physicians; 23
(II) Advanced practice registered nurses; 24
(III) Physician ((assistants or osteopathic physician 25
assistants)) associates; 26
(IV) Registered nurses; 27
(V) Dentists; 28
(VI) Naturopaths; or 29
(VII) Pharmacists; 30
(ii) Consumers of public health. This category consists of health 31
district residents who have self-identified as having faced 32
significant health inequities or as having lived experiences with 33
public health-related programs such as: The special supplemental 34
nutrition program for women, infants, and children; the supplemental 35
nutrition program; home visiting; or treatment services. It is 36
strongly encouraged that individuals from historically marginalized 37
and underrepresented communities are given preference. These 38
individuals may not be elected officials, and may not have any 39
fiduciary obligation to a health facility or other health agency, and 40
p. 135 HB 2127
may not have a material financial interest in the rendering of health 1
services; and 2
(iii) Other community stakeholders. This category consists of 3
persons representing the following types of organizations located in 4
the health district: 5
(A) Community-based organizations or nonprofits that work with 6
populations experiencing health inequities in the health district;7
(B) Active, reserve, or retired armed services members;8
(C) The business community; or 9
(D) The environmental public health regulated community.10
(b) The board members selected under (a) of this subsection must 11
be approved by a majority vote of the board of county commissioners.12
(c) If the number of board members selected under (a) of this 13
subsection is evenly divisible by three, there must be an equal 14
number of members selected from each of the three categories. If 15
there are one or two members over the nearest multiple of three, 16
those members may be selected from any of the three categories. 17
However, if the board of health demonstrates that it attempted to 18
recruit members from all three categories and was unable to do so, 19
the board may select members only from the other two categories.20
(d) There may be no more than one member selected under (a) of 21
this subsection from one type of background or position.22
(e) If a federally recognized Indian tribe holds reservation or 23
trust lands within the health district, or if an urban Indian 24
organization recognized by the Indian health service and registered 25
as a 501(c)(3) organization in Washington that serves American Indian 26
and Alaska Native people provides services within the health 27
district, the board of health must allow a tribal representative from 28
each tribe and each organization, as selected by such tribe or 29
organization, to serve as a member and must notify the American 30
Indian health commission. 31
(f) The boards of county commissioners may by resolution or 32
ordinance provide for elected officials from cities and towns and 33
persons other than elected officials as members of the district board 34
of health so long as the city and county elected officials do not 35
constitute a majority of the total membership of the board.36
(g) Except as provided in (a) and (e) of this subsection, a 37
resolution or ordinance adopted under this section must specify the 38
provisions for the appointment, term, and compensation, or 39
reimbursement of expenses. 40
p. 136 HB 2127
(h) At the first meeting of a district board of health the 1
members shall elect a chair to serve for a period of one year.2
(i) The jurisdiction of the local board of health shall be 3
coextensive with the boundaries of the county. 4
(j) The local health officer, as described in RCW 70.05.050, 5
shall be appointed by the official designated under the provisions of 6
the county charter. The same official designated under the provisions 7
of the county charter may appoint an administrative officer, as 8
described in RCW 70.05.045. 9
(k) The number of members selected or included under (a) and (e) 10
of this subsection must equal the number of city and county elected 11
officials on the board of health. If a member is added under (e) of 12
this subsection, the boards of county commissioners shall modify the 13
membership of the district: 14
(i) In compliance with timelines established by the state board 15
of health in rule once such rules are in effect; and16
(ii) Until the rules in (k)(i) of this subsection are in effect, 17
within 60 days of receipt of notice of the selection of a tribal 18
representative. 19
(l) Any decision by the board of health related to the setting or 20
modification of permit, licensing, and application fees may only be 21
determined by the city and county elected officials on the board.22
(2) A local board of health comprised solely of elected officials 23
may retain this composition if the local health jurisdiction had a 24
public health advisory committee or board with its own bylaws 25
established on January 1, 2021. By January 1, 2022, the public health 26
advisory committee or board must meet the requirements established in 27
RCW 70.46.140 for community health advisory boards. Any future 28
changes to local board of health composition must meet the 29
requirements of subsection (1) of this section. 30
(3) A local board of health comprised solely of elected officials 31
and made up of three counties east of the Cascade mountains may 32
retain their current composition if the local health jurisdiction has 33
a public health advisory committee or board that meets the 34
requirements established in RCW 70.46.140 for community health 35
advisory boards by July 1, 2022. If such a local board of health does 36
not establish the required community health advisory board by July 1, 37
2022, it must comply with the requirements of subsection (1) of this 38
section. Any future changes to local board of health composition must 39
meet the requirements of subsection (1) of this section.40
p. 137 HB 2127
Sec. 90. RCW 70.46.031 and 2025 c 260 s 4 are each amended to 1
read as follows: 2
(1) Except as provided in subsection (2) of this section, a 3
health district to consist of one county may be created whenever the 4
county legislative authority of the county shall pass a resolution or 5
ordinance to organize such a health district under chapter 70.05 RCW 6
and this chapter. The resolution or ordinance may specify the 7
membership, representation on the district health board, or other 8
matters relative to the formation or operation of the health 9
district. In addition to the membership of the district health board 10
determined through resolution or ordinance, the district health board 11
must also include the members selected under (a) and (e) of this 12
subsection. 13
(a) The remaining board members must be persons who are not 14
elected officials and must be selected from the following categories 15
consistent with the requirements of this section and the rules 16
adopted by the state board of health under RCW 43.20.300:17
(i) Public health, health care facilities, and providers. This 18
category consists of persons practicing or employed in the county who 19
are: 20
(A) Medical ethicists; 21
(B) Epidemiologists; 22
(C) Experienced in environmental public health, such as a 23
registered sanitarian; 24
(D) Community health workers; 25
(E) Holders of master's degrees or higher in public health or the 26
equivalent; 27
(F) Employees of a hospital located in the county; or28
(G) Any of the following providers holding an active or retired 29
license in good standing under Title 18 RCW: 30
(I) Physicians or osteopathic physicians; 31
(II) Advanced practice registered nurses; 32
(III) Physician ((assistants or osteopathic physician 33
assistants)) associates; 34
(IV) Registered nurses; 35
(V) Dentists; 36
(VI) Naturopaths; or 37
(VII) Pharmacists; 38
(ii) Consumers of public health. This category consists of county 39
residents who have self-identified as having faced significant health 40
p. 138 HB 2127
inequities or as having lived experiences with public health-related 1
programs such as: The special supplemental nutrition program for 2
women, infants, and children; the supplemental nutrition program; 3
home visiting; or treatment services. It is strongly encouraged that 4
individuals from historically marginalized and underrepresented 5
communities are given preference. These individuals may not be 6
elected officials and may not have any fiduciary obligation to a 7
health facility or other health agency, and may not have a material 8
financial interest in the rendering of health services; and9
(iii) Other community stakeholders. This category consists of 10
persons representing the following types of organizations located in 11
the county: 12
(A) Community-based organizations or nonprofits that work with 13
populations experiencing health inequities in the county;14
(B) The business community; or 15
(C) The environmental public health regulated community.16
(b) The board members selected under (a) of this subsection must 17
be approved by a majority vote of the board of county commissioners.18
(c) If the number of board members selected under (a) of this 19
subsection is evenly divisible by three, there must be an equal 20
number of members selected from each of the three categories. If 21
there are one or two members over the nearest multiple of three, 22
those members may be selected from any of the three categories. If 23
there are two members over the nearest multiple of three, each member 24
over the nearest multiple of three must be selected from a different 25
category. However, if the board of health demonstrates that it 26
attempted to recruit members from all three categories and was unable 27
to do so, the board may select members only from the other two 28
categories. 29
(d) There may be no more than one member selected under (a) of 30
this subsection from one type of background or position.31
(e) If a federally recognized Indian tribe holds reservation or 32
trust lands within the county, or if an urban Indian organization 33
recognized by the Indian health service and registered as a 501 (c)(3) 34
organization in Washington that serves American Indian and Alaska 35
Native people provides services within the county, the board of 36
health must allow a tribal representative from each tribe and each 37
organization, as selected by such tribe or organization, to serve as 38
a member and must notify the American Indian health commission.39
p. 139 HB 2127
(f) The county legislative authority may appoint elected 1
officials from cities and towns and persons other than elected 2
officials as members of the health district board so long as the city 3
and county elected officials do not constitute a majority of the 4
total membership of the board. 5
(g) Except as provided in (a) and (e) of this subsection, a 6
resolution or ordinance adopted under this section must specify the 7
provisions for the appointment, term, and compensation, or 8
reimbursement of expenses. 9
(h) The jurisdiction of the local board of health shall be 10
coextensive with the boundaries of the county. 11
(i) The local health officer, as described in RCW 70.05.050, 12
shall be appointed by the official designated under the provisions of 13
the resolution or ordinance. The same official designated under the 14
provisions of the resolution or ordinance may appoint an 15
administrative officer, as described in RCW 70.05.045.16
(j) At the first meeting of a district board of health the 17
members shall elect a chair to serve for a period of one year.18
(k) The number of members selected or included under (a) and (e) 19
of this subsection must equal the number of city and county elected 20
officials on the board of health. If a member is added under (e) of 21
this subsection, the county legislative authority shall modify the 22
membership of the district: 23
(i) In compliance with timelines established by the state board 24
of health in rule once such rules are in effect; and25
(ii) Until the rules in (k)(i) of this subsection are in effect, 26
within 60 days of receipt of notice of the selection of a tribal 27
representative. 28
(l) Any decision by the board of health related to the setting or 29
modification of permit, licensing, and application fees may only be 30
determined by the city and county elected officials on the board.31
(2) A local board of health comprised solely of elected officials 32
may retain this composition if the local health jurisdiction had a 33
public health advisory committee or board with its own bylaws 34
established on January 1, 2021. By January 1, 2022, the public health 35
advisory committee or board must meet the requirements established in 36
RCW 70.46.140 for community health advisory boards. Any future 37
changes to local board of health composition must meet the 38
requirements of subsection (1) of this section. 39
p. 140 HB 2127
Sec. 91. RCW 70.47.210 and 2025 c 58 s 5134 are each amended to 1
read as follows: 2
(1) Any schedule of benefits established or renewed by the 3
Washington basic health plan after December 31, 2006, shall provide 4
coverage for prostate cancer screening, provided that the screening 5
is delivered upon the recommendation of the patient's physician, 6
advanced practice registered nurse, or physician ((assistant)) 7
associate. 8
(2) This section shall not be construed to prevent the 9
application of standard policy provisions applicable to other 10
benefits, such as deductible or copayment provisions. This section 11
does not limit the authority of the health care authority to 12
negotiate rates and contract with specific providers for the delivery 13
of prostate cancer screening services. 14
Sec. 92. RCW 70.54.400 and 2025 c 58 s 5137 are each amended to 15
read as follows: 16
(1) For purposes of this section: 17
(a) "Customer" means an individual who is lawfully on the 18
premises of a retail establishment. 19
(b) "Eligible medical condition" means: 20
(i) Crohn's disease, ulcerative colitis, or any other 21
inflammatory bowel disease; 22
(ii) Irritable bowel syndrome; 23
(iii) Any condition requiring use of an ostomy device; or24
(iv) Any permanent or temporary medical condition that requires 25
immediate access to a restroom. 26
(c) "Employee restroom" means a restroom intended for employees 27
only in a retail facility and not intended for customers.28
(d) "Health care provider" means an advanced practice registered 29
nurse licensed under chapter 18.79 RCW, an osteopathic physician or 30
surgeon licensed under chapter 18.57 RCW, a physician or surgeon 31
licensed under chapter 18.71 RCW, or a physician ((assistant)) 32
associate licensed under chapter 18.71A RCW. 33
(e) "Retail establishment" means a place of business open to the 34
general public for the sale of goods or services. Retail 35
establishment does not include any structure such as a filling 36
station, service station, or restaurant of eight hundred square feet 37
or less that has an employee restroom located within that structure.38
p. 141 HB 2127
(2) A retail establishment that has an employee restroom must 1
allow a customer with an eligible medical condition to use that 2
employee restroom during normal business hours if: 3
(a) The customer requesting the use of the employee restroom 4
provides in writing either: 5
(i) A signed statement by the customer's health care provider on 6
a form that has been prepared by the department of health under 7
subsection (4) of this section; or 8
(ii) An identification card that is issued by a nonprofit 9
organization whose purpose includes serving individuals who suffer 10
from an eligible medical condition; and 11
(b) One of the following conditions are met: 12
(i) The employee restroom is reasonably safe and is not located 13
in an area where providing access would create an obvious health or 14
safety risk to the customer; or 15
(ii) Allowing the customer to access the restroom facility does 16
not pose a security risk to the retail establishment or its 17
employees. 18
(3) A retail establishment that has an employee restroom must 19
allow a customer to use that employee restroom during normal business 20
hours if: 21
(a)(i) Three or more employees of the retail establishment are 22
working at the time the customer requests use of the employee 23
restroom; and 24
(ii) The retail establishment does not normally make a restroom 25
available to the public; and 26
(b)(i) The employee restroom is reasonably safe and is not 27
located in an area where providing access would create an obvious 28
health or safety risk to the customer; or 29
(ii) Allowing the customer to access the employee restroom does 30
not pose a security risk to the retail establishment or its 31
employees. 32
(4) The department of health shall develop a standard electronic 33
form that may be signed by a health care provider as evidence of the 34
existence of an eligible medical condition as required by subsection 35
(2) of this section. The form shall include a brief description of a 36
customer's rights under this section and shall be made available for 37
a customer or his or her health care provider to access by computer. 38
Nothing in this section requires the department to distribute printed 39
versions of the form. 40
p. 142 HB 2127
(5) Fraudulent use of a form as evidence of the existence of an 1
eligible medical condition is a misdemeanor punishable under RCW 2
9A.20.010. 3
(6) For a first violation of this section, the city or county 4
attorney shall issue a warning letter to the owner or operator of the 5
retail establishment, and to any employee of a retail establishment 6
who denies access to an employee restroom in violation of this 7
section, informing the owner or operator of the establishment and 8
employee of the requirements of this section. A retail establishment 9
or an employee of a retail establishment that violates this section 10
after receiving a warning letter is guilty of a class 2 civil 11
infraction under chapter 7.80 RCW. 12
(7) A retail establishment is not required to make any physical 13
changes to an employee restroom under this section and may require 14
that an employee accompany a customer or a customer with an eligible 15
medical condition to the employee restroom. 16
(8) A retail establishment or an employee of a retail 17
establishment is not civilly liable for any act or omission in 18
allowing a customer or a customer with an eligible medical condition 19
to use an employee restroom if the act or omission meets all of the 20
following: 21
(a) It is not willful or grossly negligent; 22
(b) It occurs in an area of the retail establishment that is not 23
accessible to the public; and 24
(c) It results in an injury to or death of the customer or the 25
customer with an eligible medical condition or any individual other 26
than an employee accompanying the customer or the customer with an 27
eligible medical condition. 28
Sec. 93. RCW 70.128.120 and 2025 c 58 s 5141 are each amended to 29
read as follows: 30
Each adult family home provider, applicant, and each resident 31
manager shall have the following minimum qualifications, except that 32
only applicants are required to meet the provisions of subsections 33
(10) and (11) of this section: 34
(1) Twenty-one years of age or older; 35
(2) For those applying after September 1, 2001, to be licensed as 36
providers, and for resident managers whose employment begins after 37
September 1, 2001, a United States high school diploma or high school 38
p. 143 HB 2127
equivalency certificate as provided in RCW 28B.50.536 or any English 1
or translated government documentation of the following:2
(a) Successful completion of government-approved public or 3
private school education in a foreign country that includes an annual 4
average of one thousand hours of instruction over twelve years or no 5
less than twelve thousand hours of instruction; 6
(b) A foreign college, foreign university, or United States 7
community college two-year diploma; 8
(c) Admission to, or completion of coursework at, a foreign 9
university or college for which credit was granted;10
(d) Admission to, or completion of coursework at, a United States 11
college or university for which credits were awarded;12
(e) Admission to, or completion of postgraduate coursework at, a 13
United States college or university for which credits were awarded; 14
or 15
(f) Successful passage of the United States board examination for 16
registered nursing, or any professional medical occupation for which 17
college or university education preparation was required;18
(3) Good moral and responsible character and reputation;19
(4) Literacy and the ability to communicate in the English 20
language; 21
(5) Management and administrative ability to carry out the 22
requirements of this chapter; 23
(6) Satisfactory completion of department-approved basic training 24
and continuing education training as required by RCW 74.39A.074, and 25
in rules adopted by the department; 26
(7) Satisfactory completion of department-approved, or 27
equivalent, special care training before a provider may provide 28
special care services to a resident; 29
(8) Not be disqualified by a department background check;30
(9) For those applying to be licensed as providers, and for 31
resident managers whose employment begins after August 24, 2011, at 32
least one thousand hours in the previous sixty months of successful, 33
direct caregiving experience obtained after age eighteen to 34
vulnerable adults in a licensed or contracted setting prior to 35
operating or managing an adult family home. The applicant or resident 36
manager must have credible evidence of the successful, direct 37
caregiving experience or, currently hold one of the following 38
professional licenses: Physician licensed under chapter 18.71 RCW; 39
osteopathic physician licensed under chapter 18.57 RCW; physician 40
p. 144 HB 2127
((assistant)) associate licensed under chapter 18.71A RCW; registered 1
nurse, advanced practice registered nurse, or licensed practical 2
nurse licensed under chapter 18.79 RCW; 3
(10) For applicants, proof of financial solvency, as defined in 4
rule; and 5
(11) Applicants must successfully complete an adult family home 6
administration and business planning class, prior to being granted a 7
license. The class must be a minimum of forty-eight hours of 8
classroom time and approved by the department. The department shall 9
promote and prioritize bilingual capabilities within available 10
resources and when materials are available for this purpose. Under 11
exceptional circumstances, such as the sudden and unexpected death of 12
a provider, the department may consider granting a license to an 13
applicant who has not completed the class but who meets all other 14
requirements. If the department decides to grant the license due to 15
exceptional circumstances, the applicant must have enrolled in or 16
completed the class within four months of licensure.17
Sec. 94. RCW 70.180.005 and 1991 c 332 s 27 are each amended to 18
read as follows: 19
The legislature finds that a health care access problem exists in 20
rural areas of the state because rural health care providers are 21
unable to leave the community for short-term periods of time to 22
attend required continuing education training or for personal matters 23
because their absence would leave the community without adequate 24
medical care coverage. The lack of adequate medical coverage in 25
geographically remote rural communities constitutes a threat to the 26
health and safety of the people in those communities.27
The legislature declares that it is in the public interest to 28
recruit and maintain a pool of physicians, physician ((assistants)) 29
associates, pharmacists, and advanced practice registered nurse s 30
((practitioners)) willing and able on short notice to practice in 31
rural communities on a short-term basis to meet the medical needs of 32
the community. 33
Sec. 95. RCW 70.180.009 and 1990 c 271 s 14 are each amended to 34
read as follows: 35
The legislature finds that a shortage of physicians, nurses, 36
pharmacists, and physician ((assistants)) associates exists in rural 37
areas of the state. In addition, many education programs to train 38
p. 145 HB 2127
these health care providers do not include options for practical 1
training experience in rural settings. As a result, many health care 2
providers find their current training does not prepare them for the 3
unique demands of rural practice. 4
The legislature declares that the availability of rural training 5
opportunities as a part of professional medical, nursing, pharmacist, 6
and physician ((assistant)) associate education would provide needed 7
practical experience, serve to attract providers to rural areas, and 8
help address the current shortage of these providers in rural 9
Washington. 10
Sec. 96. RCW 70.180.020 and 2025 c 58 s 5142 are each amended to 11
read as follows: 12
The department shall establish or contract for a health 13
professional temporary substitute resource pool. The purpose of the 14
pool is to provide short-term physician, physician ((assistant)) 15
associate, pharmacist, and advanced practice registered nurse 16
personnel to rural communities where these health care providers:17
(1) Are unavailable due to provider shortages;18
(2) Need time off from practice to attend continuing education 19
and other training programs; and 20
(3) Need time off from practice to attend to personal matters or 21
recover from illness. 22
The health professional temporary substitute resource pool is 23
intended to provide short-term assistance and should complement 24
active health provider recruitment efforts by rural communities where 25
shortages exist. 26
Sec. 97. RCW 70.180.030 and 2020 c 80 s 48 are each amended to 27
read as follows: 28
(1) The department, in cooperation with the University of 29
Washington school of medicine, the state's registered nursing 30
programs, the state's pharmacy programs, and other appropriate public 31
and private agencies and associations, shall develop and keep current 32
a register of physicians, physician ((assistants)) associates, 33
pharmacists, and advanced practice registered nurse s 34
((practitioners)) who are available to practice on a short-term basis 35
in rural communities of the state. The department shall list only 36
individuals who have a valid license to practice. The register shall 37
be compiled and made available to all rural hospitals, public health 38
p. 146 HB 2127
departments and districts, rural pharmacies, and other appropriate 1
public and private agencies and associations. 2
(2) Eligible health care professionals are those licensed under 3
chapters 18.57, 18.64, 18.71, and 18.71A RCW and advanced practice 4
registered nurses ((practitioners)) licensed under chapter 18.79 RCW.5
(3) Participating sites may: 6
(a) Receive reimbursement for substitute provider travel to and 7
from the rural community and for lodging at a rate determined under 8
RCW 43.03.050 and 43.03.060; and 9
(b) Receive reimbursement for the cost of malpractice insurance 10
if the services provided are not covered by the substitute provider's 11
or local provider's existing medical malpractice insurance. 12
Reimbursement for malpractice insurance shall only be made available 13
to sites that incur additional costs for substitute provider 14
coverage. 15
(4) The department may require rural communities to participate 16
in health professional recruitment programs as a condition for 17
providing a temporary substitute health care professional if the 18
community does not have adequate permanent health care personnel. To 19
the extent deemed appropriate and subject to funding, the department 20
may also require communities to participate in other programs or 21
projects, such as the rural health system project authorized in 22
chapter 70.175 RCW, that are designed to assist communities to 23
reorganize the delivery of rural health care services.24
(5) A participating site may receive reimbursement for substitute 25
provider assistance as provided for in subsection (3) of this section 26
for up to ninety days during any twelve-month period. The department 27
may modify or waive this limitation should it determine that the 28
health and safety of the community warrants a waiver or modification.29
(6) Participating sites shall: 30
(a) Be responsible for all salary expenses for the temporary 31
substitute provider. 32
(b) Provide the temporary substitute provider with referral and 33
backup coverage information. 34
Sec. 98. RCW 70.180.040 and 2025 c 58 s 5143 are each amended to 35
read as follows: 36
(1) Requests for a temporary substitute health care professional 37
may be made to the department by the certified health plan, local 38
rural hospital, public health department or district, community 39
p. 147 HB 2127
health clinic, local practicing physician, physician ((assistant)) 1
associate, pharmacist, or advanced practice registered nurse, or 2
local city or county government. 3
(2) The department may provide directly or contract for services 4
to: 5
(a) Establish a manner and form for receiving requests;6
(b) Minimize paperwork and compliance requirements for 7
participant health care professionals and entities requesting 8
assistance; and 9
(c) Respond promptly to all requests for assistance.10
(3) The department may apply for, receive, and accept gifts and 11
other payments, including property and services, from any 12
governmental or other public or private entity or person, and may 13
make arrangements as to the use of these receipts to operate the 14
pool. The department shall make available upon request to the 15
appropriate legislative committees information concerning the source, 16
amount, and use of such gifts or payments. 17
Sec. 99. RCW 70.225.040 and 2020 c 80 s 50 are each amended to 18
read as follows: 19
(1) All information submitted to the prescription monitoring 20
program is confidential, exempt from public inspection, copying, and 21
disclosure under chapter 42.56 RCW, not subject to subpoena or 22
discovery in any civil action, and protected under federal health 23
care information privacy requirements, except as provided in 24
subsections (3) through (6) of this section. Such confidentiality and 25
exemption from disclosure continues whenever information from the 26
prescription monitoring program is provided to a requestor under 27
subsection (3), (4), (5), or (6) of this section except when used in 28
proceedings specifically authorized in subsection (3), (4), or (5) of 29
this section. 30
(2) The department must maintain procedures to ensure that the 31
privacy and confidentiality of all information collected, recorded, 32
transmitted, and maintained including, but not limited to, the 33
prescriber, requestor, dispenser, patient, and persons who received 34
prescriptions from dispensers, is not disclosed to persons except as 35
in subsections (3) through (6) of this section. 36
(3) The department may provide data in the prescription 37
monitoring program to the following persons: 38
p. 148 HB 2127
(a) Persons authorized to prescribe or dispense controlled 1
substances or legend drugs, for the purpose of providing medical or 2
pharmaceutical care for their patients; 3
(b) An individual who requests the individual's own prescription 4
monitoring information; 5
(c) A health professional licensing, certification, or regulatory 6
agency or entity in this or another jurisdiction. Consistent with 7
current practice, the data provided may be used in legal proceedings 8
concerning the license; 9
(d) Appropriate law enforcement or prosecutorial officials, 10
including local, state, and federal officials and officials of 11
federally recognized tribes, who are engaged in a bona fide specific 12
investigation involving a designated person; 13
(e) The director or the director's designee within the health 14
care authority regarding medicaid recipients and members of the 15
health care authority self-funded or self-insured health plans;16
(f) The director or director's designee within the department of 17
labor and industries regarding workers' compensation claimants;18
(g) The director or the director's designee within the department 19
of corrections regarding offenders committed to the department of 20
corrections; 21
(h) Other entities under grand jury subpoena or court order;22
(i) Personnel of the department for purposes of:23
(i) Assessing prescribing and treatment practices and morbidity 24
and mortality related to use of controlled substances and developing 25
and implementing initiatives to protect the public health including, 26
but not limited to, initiatives to address opioid use disorder;27
(ii) Providing quality improvement feedback to prescribers, 28
including comparison of their respective data to aggregate data for 29
prescribers with the same type of license and same specialty; and30
(iii) Administration and enforcement of this chapter or chapter 31
69.50 RCW; 32
(j) Personnel of a test site that meet the standards under RCW 33
70.225.070 pursuant to an agreement between the test site and a 34
person identified in (a) of this subsection to provide assistance in 35
determining which medications are being used by an identified patient 36
who is under the care of that person; 37
(k) A health care facility or entity for the purpose of providing 38
medical or pharmaceutical care to the patients of the facility or 39
entity, or for quality improvement purposes if the facility or entity 40
p. 149 HB 2127
is licensed by the department or is licensed or certified under 1
chapter 71.24, 71.34, or 71.05 RCW or is an entity deemed for 2
purposes of chapter 71.24 RCW to meet state minimum standards as a 3
result of accreditation by a recognized behavioral health accrediting 4
body, or is operated by the federal government or a federally 5
recognized Indian tribe; 6
(l) A health care provider group of five or more prescribers or 7
dispensers for purposes of providing medical or pharmaceutical care 8
to the patients of the provider group, or for quality improvement 9
purposes if all the prescribers or dispensers in the provider group 10
are licensed by the department or the provider group is operated by 11
the federal government or a federally recognized Indian tribe;12
(m) The local health officer of a local health jurisdiction for 13
the purposes of patient follow-up and care coordination following a 14
controlled substance overdose event. For the purposes of this 15
subsection "local health officer" has the same meaning as in RCW 16
70.05.010; and 17
(n) The coordinated care electronic tracking program developed in 18
response to section 213, chapter 7, Laws of 2012 2nd sp. sess., 19
commonly referred to as the seven best practices in emergency 20
medicine, for the purposes of providing: 21
(i) Prescription monitoring program data to emergency department 22
personnel when the patient registers in the emergency department; and23
(ii) Notice to local health officers who have made opioid-related 24
overdose a notifiable condition under RCW 70.05.070 as authorized by 25
rules adopted under RCW 43.20.050, providers, appropriate care 26
coordination staff, and prescribers listed in the patient's 27
prescription monitoring program record that the patient has 28
experienced a controlled substance overdose event. The department 29
shall determine the content and format of the notice in consultation 30
with the Washington state hospital association, Washington state 31
medical association, and Washington state health care authority, and 32
the notice may be modified as necessary to reflect current needs and 33
best practices. 34
(4) The department shall, on at least a quarterly basis, and 35
pursuant to a schedule determined by the department, provide a 36
facility or entity identified under subsection (3)(k) of this section 37
or a provider group identified under subsection (3)(l) of this 38
section with facility or entity and individual prescriber information 39
if the facility, entity, or provider group: 40
p. 150 HB 2127
(a) Uses the information only for internal quality improvement 1
and individual prescriber quality improvement feedback purposes and 2
does not use the information as the sole basis for any medical staff 3
sanction or adverse employment action; and 4
(b) Provides to the department a standardized list of current 5
prescribers of the facility, entity, or provider group. The specific 6
facility, entity, or provider group information provided pursuant to 7
this subsection and the requirements under this subsection must be 8
determined by the department in consultation with the Washington 9
state hospital association, Washington state medical association, and 10
Washington state health care authority, and may be modified as 11
necessary to reflect current needs and best practices.12
(5)(a) The department may publish or provide data to public or 13
private entities for statistical, research, or educational purposes 14
after removing information that could be used directly or indirectly 15
to identify individual patients, requestors, dispensers, prescribers, 16
and persons who received prescriptions from dispensers. Direct and 17
indirect patient identifiers may be provided for research that has 18
been approved by the Washington state institutional review board and 19
by the department through a data-sharing agreement.20
(b)(i) The department may provide dispenser and prescriber data 21
and data that includes indirect patient identifiers to the Washington 22
state hospital association for use solely in connection with its 23
coordinated quality improvement program maintained under RCW 24
43.70.510 after entering into a data use agreement as specified in 25
RCW 43.70.052(((8))) with the association. The department may provide 26
dispenser and prescriber data and data that includes indirect patient 27
identifiers to the Washington state medical association for use 28
solely in connection with its coordinated quality improvement program 29
maintained under RCW 43.70.510 after entering into a data use 30
agreement with the association. 31
(ii) The department may provide data including direct and 32
indirect patient identifiers to the department of social and health 33
services office of research and data analysis, the department of 34
labor and industries, and the health care authority for research that 35
has been approved by the Washington state institutional review board 36
and, with a data-sharing agreement approved by the department, for 37
public health purposes to improve the prevention or treatment of 38
substance use disorders. 39
p. 151 HB 2127
(iii) The department may provide a prescriber feedback report to 1
the largest health professional association representing each of the 2
prescribing professions. The health professional associations must 3
distribute the feedback report to prescribers engaged in the 4
professions represented by the associations for quality improvement 5
purposes, so long as the reports contain no direct patient 6
identifiers that could be used to identify individual patients, 7
dispensers, and persons who received prescriptions from dispensers, 8
and the association enters into a written data-sharing agreement with 9
the department. However, reports may include indirect patient 10
identifiers as agreed to by the department and the association in a 11
written data-sharing agreement. 12
(c) For the purposes of this subsection: 13
(i) "Indirect patient identifiers" means data that may include: 14
Hospital or provider identifiers, a five-digit zip code, county, 15
state, and country of resident; dates that include month and year; 16
age in years; and race and ethnicity; but does not include the 17
patient's first name; middle name; last name; social security number; 18
control or medical record number; zip code plus four digits; dates 19
that include day, month, and year; or admission and discharge date in 20
combination; and 21
(ii) "Prescribing professions" include: 22
(A) Allopathic physicians and physician ((assistants)) 23
associates; 24
(B) Osteopathic physicians; 25
(C) Podiatric physicians; 26
(D) Dentists; and 27
(E) Advanced practice registered nurses ((practitioners)).28
(6) The department may enter into agreements to exchange 29
prescription monitoring program data with established prescription 30
monitoring programs in other jurisdictions. Under these agreements, 31
the department may share prescription monitoring system data 32
containing direct and indirect patient identifiers with other 33
jurisdictions through a clearinghouse or prescription monitoring 34
program data exchange that meets federal health care information 35
privacy requirements. Data the department receives from other 36
jurisdictions must be retained, used, protected, and destroyed as 37
provided by the agreements to the extent consistent with the laws in 38
this state. 39
p. 152 HB 2127
(7) Persons authorized in subsections (3) through (6) of this 1
section to receive data in the prescription monitoring program from 2
the department, acting in good faith, are immune from any civil, 3
criminal, disciplinary, or administrative liability that might 4
otherwise be incurred or imposed for acting under this chapter.5
Sec. 100. RCW 70.245.010 and 2025 c 58 s 5144 are each amended 6
to read as follows: 7
The definitions in this section apply throughout this chapter 8
unless the context clearly requires otherwise. 9
(1) "Adult" means an individual who is 18 years of age or older.10
(2) "Attending qualified medical provider" means the qualified 11
medical provider who has primary responsibility for the care of the 12
patient and treatment of the patient's terminal disease.13
(3) "Competent" means that, in the opinion of a court or in the 14
opinion of the patient's attending qualified medical provider, 15
consulting qualified medical provider, psychiatrist, or psychologist, 16
a patient has the ability to make and communicate an informed 17
decision to health care providers, including communication through 18
persons familiar with the patient's manner of communicating if those 19
persons are available. 20
(4) "Consulting qualified medical provider" means a qualified 21
medical provider who is qualified by specialty or experience to make 22
a professional diagnosis and prognosis regarding the patient's 23
disease. 24
(5) "Counseling" means one or more consultations as necessary 25
between a state licensed psychiatrist, psychologist, independent 26
clinical social worker, advanced social worker, mental health 27
counselor, or psychiatric advanced practice registered nurse and a 28
patient for the purpose of determining that the patient is competent 29
and not suffering from a psychiatric or psychological disorder or 30
depression causing impaired judgment. 31
(6) "Health care provider" means a person licensed, certified, or 32
otherwise authorized or permitted by law to administer health care or 33
dispense medication in the ordinary course of business or practice of 34
a profession, and includes a health care facility.35
(7) "Informed decision" means a decision by a qualified patient, 36
to request and obtain a prescription for medication that the 37
qualified patient may self-administer to end his or her life in a 38
humane and dignified manner, that is based on an appreciation of the 39
p. 153 HB 2127
relevant facts and after being fully informed by the attending 1
qualified medical provider of: 2
(a) His or her medical diagnosis; 3
(b) His or her prognosis; 4
(c) The potential risks associated with taking the medication to 5
be prescribed; 6
(d) The probable result of taking the medication to be 7
prescribed; and 8
(e) The feasible alternatives including, but not limited to, 9
comfort care, hospice care, and pain control. 10
(8) "Medically confirmed" means the medical opinion of the 11
attending qualified medical provider has been confirmed by a 12
consulting qualified medical provider who has examined the patient 13
and the patient's relevant medical records. 14
(9) "Patient" means a person who is under the care of an 15
attending qualified medical provider. 16
(10) "Qualified medical provider" means a physician licensed 17
under chapter 18.57 or 18.71 RCW, a physician ((assistant)) associate 18
licensed under chapter 18.71A RCW, or an advanced practice registered 19
nurse licensed under chapter 18.79 RCW. 20
(11) "Qualified patient" means a competent adult who is a 21
resident of Washington state and has satisfied the requirements of 22
this chapter in order to obtain a prescription for medication that 23
the qualified patient may self-administer to end his or her life in a 24
humane and dignified manner. 25
(12) "Self-administer" means a qualified patient's act of 26
ingesting medication to end his or her life in a humane and dignified 27
manner. 28
(13) "Terminal disease" means an incurable and irreversible 29
disease that has been medically confirmed and will, within reasonable 30
medical judgment, produce death within six months.31
Sec. 101. RCW 71.05.020 and 2025 c 226 s 1 are each amended to 32
read as follows: 33
The definitions in this section apply throughout this chapter 34
unless the context clearly requires otherwise. 35
(1) "23-hour crisis relief center" has the same meaning as under 36
RCW 71.24.025; 37
(2) "Admission" or "admit" means a decision by a physician, 38
physician ((assistant)) associate, or psychiatric advanced registered 39
p. 154 HB 2127
nurse practitioner that a person should be examined or treated as a 1
patient in a hospital; 2
(3) "Alcoholism" means a disease, characterized by a dependency 3
on alcoholic beverages, loss of control over the amount and 4
circumstances of use, symptoms of tolerance, physiological or 5
psychological withdrawal, or both, if use is reduced or discontinued, 6
and impairment of health or disruption of social or economic 7
functioning; 8
(4) "Antipsychotic medications" means that class of drugs 9
primarily used to treat serious manifestations of mental illness 10
associated with thought disorders, which includes, but is not limited 11
to atypical antipsychotic medications; 12
(5) "Approved substance use disorder treatment program" means a 13
program for persons with a substance use disorder provided by a 14
treatment program certified by the department as meeting standards 15
adopted under chapter 71.24 RCW; 16
(6) "Attending staff" means any person on the staff of a public 17
or private agency having responsibility for the care and treatment of 18
a patient; 19
(7) "Authority" means the Washington state health care authority;20
(8) "Behavioral health disorder" means either a mental disorder 21
as defined in this section, a substance use disorder as defined in 22
this section, or a co-occurring mental disorder and substance use 23
disorder; 24
(9) "Behavioral health service provider" means a public or 25
private agency that provides mental health, substance use disorder, 26
or co-occurring disorder services to persons with behavioral health 27
disorders as defined under this section and receives funding from 28
public sources. This includes, but is not limited to: Hospitals 29
licensed under chapter 70.41 RCW; evaluation and treatment facilities 30
as defined in this section; community mental health service delivery 31
systems or community behavioral health programs as defined in RCW 32
71.24.025; licensed or certified behavioral health agencies under RCW 33
71.24.037; an entity with a tribal attestation that it meets minimum 34
standards or a licensed or certified behavioral health agency as 35
defined in RCW 71.24.025; facilities conducting competency 36
evaluations and restoration under chapter 10.77 RCW; approved 37
substance use disorder treatment programs as defined in this section; 38
secure withdrawal management and stabilization facilities as defined 39
p. 155 HB 2127
in this section; and correctional facilities operated by state, 1
local, and tribal governments; 2
(10) "Co-occurring disorder specialist" means an individual 3
possessing an enhancement granted by the department of health under 4
chapter 18.205 RCW that certifies the individual to provide substance 5
use disorder counseling subject to the practice limitations under RCW 6
18.205.105; 7
(11) "Commitment" means the determination by a court that a 8
person should be detained for a period of either evaluation or 9
treatment, or both, in an inpatient or a less restrictive setting;10
(12) "Community behavioral health agency" has the same meaning as 11
"licensed or certified behavioral health agency" defined in RCW 12
71.24.025; 13
(13) "Conditional release" means a revocable modification of a 14
commitment, which may be revoked upon violation of any of its terms;15
(14) "Crisis stabilization unit" means a short-term facility or a 16
portion of a facility licensed or certified by the department, such 17
as an evaluation and treatment facility or a hospital, which has been 18
designed to assess, diagnose, and treat individuals experiencing an 19
acute crisis without the use of long-term hospitalization, or to 20
determine the need for involuntary commitment of an individual;21
(15) "Custody" means involuntary detention under the provisions 22
of this chapter or chapter 10.77 RCW, uninterrupted by any period of 23
unconditional release from commitment from a facility providing 24
involuntary care and treatment; 25
(16) "Department" means the department of health;26
(17) "Designated crisis responder" means a mental health 27
professional appointed by the county, by an entity appointed by the 28
county, or by the authority in consultation with a tribe or after 29
meeting and conferring with an Indian health care provider, to 30
perform the duties specified in this chapter; 31
(18) "Detention" or "detain" means the lawful confinement of a 32
person, under the provisions of this chapter; 33
(19) "Developmental disabilities professional" means a person who 34
has specialized training and three years of experience in directly 35
treating or working with persons with developmental disabilities and 36
is a psychiatrist, physician ((assistant)) associate working with a 37
psychiatrist who is acting as a participating physician as defined in 38
RCW 18.71A.010, psychologist, psychiatric advanced registered nurse 39
practitioner, or social worker, and such other developmental 40
p. 156 HB 2127
disabilities professionals as may be defined by rules adopted by the 1
secretary of the department of social and health services;2
(20) "Developmental disability" means that condition defined in 3
RCW 71A.10.020(6); 4
(21) "Director" means the director of the authority;5
(22) "Discharge" means the termination of hospital medical 6
authority. The commitment may remain in place, be terminated, or be 7
amended by court order; 8
(23) "Drug addiction" means a disease, characterized by a 9
dependency on psychoactive chemicals, loss of control over the amount 10
and circumstances of use, symptoms of tolerance, physiological or 11
psychological withdrawal, or both, if use is reduced or discontinued, 12
and impairment of health or disruption of social or economic 13
functioning; 14
(24) "Evaluation and treatment facility" means any facility which 15
can provide directly, or by direct arrangement with other public or 16
private agencies, emergency evaluation and treatment, outpatient 17
care, and timely and appropriate inpatient care to persons suffering 18
from a mental disorder, and which is licensed or certified as such by 19
the department. The authority may certify single beds as temporary 20
evaluation and treatment beds under RCW 71.05.745. A physically 21
separate and separately operated portion of a state hospital may be 22
designated as an evaluation and treatment facility. A facility which 23
is part of, or operated by, the department of social and health 24
services or any federal agency will not require certification. No 25
correctional institution or facility, or jail, shall be an evaluation 26
and treatment facility within the meaning of this chapter;27
(25) "Gravely disabled" means a condition in which a person, as a 28
result of a behavioral health disorder: (a) Is in danger of serious 29
physical harm resulting from a failure to provide for his or her 30
essential human needs of health or safety; or (b) manifests severe 31
deterioration in routine functioning evidenced by repeated and 32
escalating loss of cognitive or volitional control over his or her 33
actions and is not receiving such care as is essential for his or her 34
health or safety; 35
(26) "Habilitative services" means those services provided by 36
program personnel to assist persons in acquiring and maintaining life 37
skills and in raising their levels of physical, mental, social, and 38
vocational functioning. Habilitative services include education, 39
training for employment, and therapy. The habilitative process shall 40
p. 157 HB 2127
be undertaken with recognition of the risk to the public safety 1
presented by the person being assisted as manifested by prior charged 2
criminal conduct; 3
(27) "Hearing" means any proceeding conducted in open court that 4
conforms to the requirements of RCW 71.05.820; 5
(28) "History of one or more violent acts" refers to the period 6
of time ten years prior to the filing of a petition under this 7
chapter, excluding any time spent, but not any violent acts 8
committed, in a behavioral health facility, or in confinement as a 9
result of a criminal conviction; 10
(29) "Imminent" means the state or condition of being likely to 11
occur at any moment or near at hand, rather than distant or remote;12
(30) "In need of assisted outpatient treatment" refers to a 13
person who meets the criteria for assisted outpatient treatment 14
established under RCW 71.05.148; 15
(31) "Individualized service plan" means a plan prepared by a 16
developmental disabilities professional with other professionals as a 17
team, for a person with developmental disabilities, which shall 18
state: 19
(a) The nature of the person's specific problems, prior charged 20
criminal behavior, and habilitation needs; 21
(b) The conditions and strategies necessary to achieve the 22
purposes of habilitation; 23
(c) The intermediate and long-range goals of the habilitation 24
program, with a projected timetable for the attainment;25
(d) The rationale for using this plan of habilitation to achieve 26
those intermediate and long-range goals; 27
(e) The staff responsible for carrying out the plan;28
(f) Where relevant in light of past criminal behavior and due 29
consideration for public safety, the criteria for proposed movement 30
to less-restrictive settings, criteria for proposed eventual 31
discharge or release, and a projected possible date for discharge or 32
release; and 33
(g) The type of residence immediately anticipated for the person 34
and possible future types of residences; 35
(32) "Intoxicated person" means a person whose mental or physical 36
functioning is substantially impaired as a result of the use of 37
alcohol or other psychoactive chemicals; 38
(33) "Judicial commitment" means a commitment by a court pursuant 39
to the provisions of this chapter; 40
p. 158 HB 2127
(34) "Legal counsel" means attorneys and staff employed by county 1
prosecutor offices or the state attorney general acting in their 2
capacity as legal representatives of public behavioral health service 3
providers under RCW 71.05.130; 4
(35) "Less restrictive alternative treatment" means a program of 5
individualized treatment in a less restrictive setting than inpatient 6
treatment that includes the services described in RCW 71.05.585. This 7
term includes: Treatment pursuant to a less restrictive alternative 8
treatment order under RCW 71.05.240 or 71.05.320; treatment pursuant 9
to a conditional release under RCW 71.05.340; and treatment pursuant 10
to an assisted outpatient treatment order under RCW 71.05.148;11
(36) "Licensed physician" means a person licensed to practice 12
medicine or osteopathic medicine and surgery in the state of 13
Washington; 14
(37) "Likelihood of serious harm" means: 15
(a) A substantial risk that: (i) Physical harm will be inflicted 16
by a person upon his or her own person, as evidenced by threats or 17
attempts to commit suicide or inflict physical harm on oneself; (ii) 18
physical harm will be inflicted by a person upon another, as 19
evidenced by behavior which has caused such harm or which places 20
another person or persons in reasonable fear of sustaining such harm; 21
or (iii) physical harm will be inflicted by a person upon the 22
property of others, as evidenced by behavior which has caused 23
substantial loss or damage to the property of others; or24
(b) The person has threatened the physical safety of another and 25
has a history of one or more violent acts; 26
(38) "Medical clearance" means a physician or other health care 27
provider, including an Indian health care provider, has determined 28
that a person is medically stable and ready for referral to the 29
designated crisis responder or facility. For a person presenting in 30
the community, no medical clearance is required prior to 31
investigation by a designated crisis responder; 32
(39) "Mental disorder" means any organic, mental, or emotional 33
impairment which has substantial adverse effects on a person's 34
cognitive or volitional functions; 35
(40) "Mental health professional" means an individual practicing 36
within the mental health professional's statutory scope of practice 37
who is: 38
(a) A psychiatrist, psychologist, physician ((assistant)) 39
associate working with a psychiatrist who is acting as a 40
p. 159 HB 2127
participating physician as defined in RCW 18.71A.010, psychiatric 1
advanced registered nurse practitioner, psychiatric nurse, or social 2
worker, as defined in this chapter and chapter 71.34 RCW;3
(b) A mental health counselor, mental health counselor associate, 4
marriage and family therapist, or marriage and family therapist 5
associate, as defined in chapter 18.225 RCW; 6
(c) A certified or licensed agency affiliated counselor, as 7
defined in chapter 18.19 RCW; or 8
(d) A licensed psychological associate as described in chapter 9
18.83 RCW; 10
(41) "Peace officer" means a law enforcement official of a public 11
agency or governmental unit, and includes persons specifically given 12
peace officer powers by any state law, local ordinance, or judicial 13
order of appointment; 14
(42) "Physician ((assistant)) associate" means a person licensed 15
as a physician ((assistant)) associate under chapter 18.71A RCW;16
(43) "Private agency" means any person, partnership, corporation, 17
or association that is not a public agency, whether or not financed 18
in whole or in part by public funds, which constitutes an evaluation 19
and treatment facility or private institution, or hospital, or 20
approved substance use disorder treatment program, which is conducted 21
for, or includes a department or ward conducted for, the care and 22
treatment of persons with behavioral health disorders;23
(44) "Professional person" means a mental health professional, 24
substance use disorder professional, or designated crisis responder 25
and shall also mean a physician, physician ((assistant)) associate, 26
psychiatric advanced registered nurse practitioner, registered nurse, 27
and such others as may be defined by rules adopted by the secretary 28
pursuant to the provisions of this chapter; 29
(45) "Psychiatric advanced registered nurse practitioner" means a 30
person who is licensed as an advanced practice registered nurse 31
((practitioner)) pursuant to chapter 18.79 RCW; and who is board 32
certified in advanced practice psychiatric and mental health nursing;33
(46) "Psychiatrist" means a person having a license as a 34
physician and surgeon in this state who has in addition completed 35
three years of graduate training in psychiatry in a program approved 36
by the American medical association or the American osteopathic 37
association and is certified or eligible to be certified by the 38
American board of psychiatry and neurology; 39
p. 160 HB 2127
(47) "Psychologist" means a person who has been licensed as a 1
psychologist pursuant to chapter 18.83 RCW; 2
(48) "Public agency" means any evaluation and treatment facility 3
or institution, secure withdrawal management and stabilization 4
facility, approved substance use disorder treatment program, or 5
hospital which is conducted for, or includes a department or ward 6
conducted for, the care and treatment of persons with behavioral 7
health disorders, if the agency is operated directly by federal, 8
state, county, or municipal government, or a combination of such 9
governments; 10
(49) "Release" means legal termination of the commitment under 11
the provisions of this chapter; 12
(50) "Resource management services" has the meaning given in 13
chapter 71.24 RCW; 14
(51) "Secretary" means the secretary of the department of health, 15
or his or her designee; 16
(52) "Secure withdrawal management and stabilization facility" 17
means a facility operated by either a public or private agency or by 18
the program of an agency which provides care to voluntary individuals 19
and individuals involuntarily detained and committed under this 20
chapter for whom there is a likelihood of serious harm or who are 21
gravely disabled due to the presence of a substance use disorder. 22
Secure withdrawal management and stabilization facilities must:23
(a) Provide the following services: 24
(i) Assessment and treatment, provided by certified substance use 25
disorder professionals or co-occurring disorder specialists;26
(ii) Clinical stabilization services; 27
(iii) Acute or subacute detoxification services for intoxicated 28
individuals; and 29
(iv) Discharge assistance provided by certified substance use 30
disorder professionals or co-occurring disorder specialists, 31
including facilitating transitions to appropriate voluntary or 32
involuntary inpatient services or to less restrictive alternatives as 33
appropriate for the individual; 34
(b) Include security measures sufficient to protect the patients, 35
staff, and community; and 36
(c) Be licensed or certified as such by the department of health;37
(53) "Social worker" means a person with a master's or further 38
advanced degree from a social work educational program accredited and 39
approved as provided in RCW 18.320.010; 40
p. 161 HB 2127
(54) "State facility" means: 1
(a) The center for behavioral health and learning located on the 2
University of Washington medical center northwest campus; and3
(b) Facilities owned or operated by the department of social and 4
health services that are not state hospitals that provide inpatient 5
services to individuals under this chapter; 6
(55) "State hospital" means a hospital designated under RCW 7
72.23.020; 8
(56) "Substance use disorder" means a cluster of cognitive, 9
behavioral, and physiological symptoms indicating that an individual 10
continues using the substance despite significant substance-related 11
problems. The diagnosis of a substance use disorder is based on a 12
pathological pattern of behaviors related to the use of the 13
substances; 14
(57) "Substance use disorder professional" means a person 15
certified as a substance use disorder professional by the department 16
of health under chapter 18.205 RCW; 17
(58) "Therapeutic court personnel" means the staff of a mental 18
health court or other therapeutic court which has jurisdiction over 19
defendants who are dually diagnosed with mental disorders, including 20
court personnel, probation officers, a court monitor, prosecuting 21
attorney, or defense counsel acting within the scope of therapeutic 22
court duties; 23
(59) "Treatment records" include registration and all other 24
records concerning persons who are receiving or who at any time have 25
received services for behavioral health disorders, which are 26
maintained by the department of social and health services, the 27
department, the authority, behavioral health administrative services 28
organizations and their staffs, managed care organizations and their 29
staffs, and by treatment facilities. Treatment records include mental 30
health information contained in a medical bill including but not 31
limited to mental health drugs, a mental health diagnosis, provider 32
name, and dates of service stemming from a medical service. Treatment 33
records do not include notes or records maintained for personal use 34
by a person providing treatment services for the department of social 35
and health services, the department, the authority, behavioral health 36
administrative services organizations, managed care organizations, or 37
a treatment facility if the notes or records are not available to 38
others; 39
(60) "Tribe" has the same meaning as in RCW 71.24.025;40
p. 162 HB 2127
(61) "Video," unless the context clearly indicates otherwise, 1
means the delivery of behavioral health services through the use of 2
interactive audio and video technology, permitting real-time 3
communication between a person and a designated crisis responder, for 4
the purpose of evaluation. "Video" does not include the use of audio-5
only telephone, facsimile, email, or store and forward technology. 6
"Store and forward technology" means use of an asynchronous 7
transmission of a person's medical information from a mental health 8
service provider to the designated crisis responder which results in 9
medical diagnosis, consultation, or treatment; 10
(62) "Violent act" means behavior that resulted in homicide, 11
attempted suicide, injury, or substantial loss or damage to property.12
Sec. 102. RCW 71.05.020 and 2025 c 226 s 2 are each amended to 13
read as follows: 14
The definitions in this section apply throughout this chapter 15
unless the context clearly requires otherwise. 16
(1) "23-hour crisis relief center" has the same meaning as under 17
RCW 71.24.025; 18
(2) "Admission" or "admit" means a decision by a physician, 19
physician ((assistant)) associate, or psychiatric advanced registered 20
nurse practitioner that a person should be examined or treated as a 21
patient in a hospital; 22
(3) "Alcoholism" means a disease, characterized by a dependency 23
on alcoholic beverages, loss of control over the amount and 24
circumstances of use, symptoms of tolerance, physiological or 25
psychological withdrawal, or both, if use is reduced or discontinued, 26
and impairment of health or disruption of social or economic 27
functioning; 28
(4) "Antipsychotic medications" means that class of drugs 29
primarily used to treat serious manifestations of mental illness 30
associated with thought disorders, which includes, but is not limited 31
to atypical antipsychotic medications; 32
(5) "Approved substance use disorder treatment program" means a 33
program for persons with a substance use disorder provided by a 34
treatment program certified by the department as meeting standards 35
adopted under chapter 71.24 RCW; 36
(6) "Attending staff" means any person on the staff of a public 37
or private agency having responsibility for the care and treatment of 38
a patient; 39
p. 163 HB 2127
(7) "Authority" means the Washington state health care authority;1
(8) "Behavioral health disorder" means either a mental disorder 2
as defined in this section, a substance use disorder as defined in 3
this section, or a co-occurring mental disorder and substance use 4
disorder; 5
(9) "Behavioral health service provider" means a public or 6
private agency that provides mental health, substance use disorder, 7
or co-occurring disorder services to persons with behavioral health 8
disorders as defined under this section and receives funding from 9
public sources. This includes, but is not limited to: Hospitals 10
licensed under chapter 70.41 RCW; evaluation and treatment facilities 11
as defined in this section; community mental health service delivery 12
systems or community behavioral health programs as defined in RCW 13
71.24.025; licensed or certified behavioral health agencies under RCW 14
71.24.037; an entity with a tribal attestation that it meets minimum 15
standards or a licensed or certified behavioral health agency as 16
defined in RCW 71.24.025; facilities conducting competency 17
evaluations and restoration under chapter 10.77 RCW; approved 18
substance use disorder treatment programs as defined in this section; 19
secure withdrawal management and stabilization facilities as defined 20
in this section; and correctional facilities operated by state, 21
local, and tribal governments; 22
(10) "Co-occurring disorder specialist" means an individual 23
possessing an enhancement granted by the department of health under 24
chapter 18.205 RCW that certifies the individual to provide substance 25
use disorder counseling subject to the practice limitations under RCW 26
18.205.105; 27
(11) "Commitment" means the determination by a court that a 28
person should be detained for a period of either evaluation or 29
treatment, or both, in an inpatient or a less restrictive setting;30
(12) "Community behavioral health agency" has the same meaning as 31
"licensed or certified behavioral health agency" defined in RCW 32
71.24.025; 33
(13) "Conditional release" means a revocable modification of a 34
commitment, which may be revoked upon violation of any of its terms;35
(14) "Crisis stabilization unit" means a short-term facility or a 36
portion of a facility licensed or certified by the department, such 37
as an evaluation and treatment facility or a hospital, which has been 38
designed to assess, diagnose, and treat individuals experiencing an 39
p. 164 HB 2127
acute crisis without the use of long-term hospitalization, or to 1
determine the need for involuntary commitment of an individual;2
(15) "Custody" means involuntary detention under the provisions 3
of this chapter or chapter 10.77 RCW, uninterrupted by any period of 4
unconditional release from commitment from a facility providing 5
involuntary care and treatment; 6
(16) "Department" means the department of health;7
(17) "Designated crisis responder" means a mental health 8
professional appointed by the county, by an entity appointed by the 9
county, or by the authority in consultation with a tribe or after 10
meeting and conferring with an Indian health care provider, to 11
perform the duties specified in this chapter; 12
(18) "Detention" or "detain" means the lawful confinement of a 13
person, under the provisions of this chapter; 14
(19) "Developmental disabilities professional" means a person who 15
has specialized training and three years of experience in directly 16
treating or working with persons with developmental disabilities and 17
is a psychiatrist, physician ((assistant)) associate working with a 18
psychiatrist who is acting as a participating physician as defined in 19
RCW 18.71A.010, psychologist, psychiatric advanced registered nurse 20
practitioner, or social worker, and such other developmental 21
disabilities professionals as may be defined by rules adopted by the 22
secretary of the department of social and health services;23
(20) "Developmental disability" means that condition defined in 24
RCW 71A.10.020(6); 25
(21) "Director" means the director of the authority;26
(22) "Discharge" means the termination of hospital medical 27
authority. The commitment may remain in place, be terminated, or be 28
amended by court order; 29
(23) "Drug addiction" means a disease, characterized by a 30
dependency on psychoactive chemicals, loss of control over the amount 31
and circumstances of use, symptoms of tolerance, physiological or 32
psychological withdrawal, or both, if use is reduced or discontinued, 33
and impairment of health or disruption of social or economic 34
functioning; 35
(24) "Evaluation and treatment facility" means any facility which 36
can provide directly, or by direct arrangement with other public or 37
private agencies, emergency evaluation and treatment, outpatient 38
care, and timely and appropriate inpatient care to persons suffering 39
from a mental disorder, and which is licensed or certified as such by 40
p. 165 HB 2127
the department. The authority may certify single beds as temporary 1
evaluation and treatment beds under RCW 71.05.745. A physically 2
separate and separately operated portion of a state hospital may be 3
designated as an evaluation and treatment facility. A facility which 4
is part of, or operated by, the department of social and health 5
services or any federal agency will not require certification. No 6
correctional institution or facility, or jail, shall be an evaluation 7
and treatment facility within the meaning of this chapter;8
(25) "Gravely disabled" means a condition in which a person, as a 9
result of a behavioral health disorder: (a) Is in danger of serious 10
physical harm resulting from a failure to provide for his or her 11
essential human needs of health or safety; or (b) manifests severe 12
deterioration from safe behavior evidenced by repeated and escalating 13
loss of cognitive or volitional control over his or her actions and 14
is not receiving such care as is essential for his or her health or 15
safety; 16
(26) "Habilitative services" means those services provided by 17
program personnel to assist persons in acquiring and maintaining life 18
skills and in raising their levels of physical, mental, social, and 19
vocational functioning. Habilitative services include education, 20
training for employment, and therapy. The habilitative process shall 21
be undertaken with recognition of the risk to the public safety 22
presented by the person being assisted as manifested by prior charged 23
criminal conduct; 24
(27) "Hearing" means any proceeding conducted in open court that 25
conforms to the requirements of RCW 71.05.820; 26
(28) "History of one or more violent acts" refers to the period 27
of time ten years prior to the filing of a petition under this 28
chapter, excluding any time spent, but not any violent acts 29
committed, in a behavioral health facility, or in confinement as a 30
result of a criminal conviction; 31
(29) "Imminent" means the state or condition of being likely to 32
occur at any moment or near at hand, rather than distant or remote;33
(30) "In need of assisted outpatient treatment" refers to a 34
person who meets the criteria for assisted outpatient treatment 35
established under RCW 71.05.148; 36
(31) "Individualized service plan" means a plan prepared by a 37
developmental disabilities professional with other professionals as a 38
team, for a person with developmental disabilities, which shall 39
state: 40
p. 166 HB 2127
(a) The nature of the person's specific problems, prior charged 1
criminal behavior, and habilitation needs; 2
(b) The conditions and strategies necessary to achieve the 3
purposes of habilitation; 4
(c) The intermediate and long-range goals of the habilitation 5
program, with a projected timetable for the attainment;6
(d) The rationale for using this plan of habilitation to achieve 7
those intermediate and long-range goals; 8
(e) The staff responsible for carrying out the plan;9
(f) Where relevant in light of past criminal behavior and due 10
consideration for public safety, the criteria for proposed movement 11
to less-restrictive settings, criteria for proposed eventual 12
discharge or release, and a projected possible date for discharge or 13
release; and 14
(g) The type of residence immediately anticipated for the person 15
and possible future types of residences; 16
(32) "Intoxicated person" means a person whose mental or physical 17
functioning is substantially impaired as a result of the use of 18
alcohol or other psychoactive chemicals; 19
(33) "Judicial commitment" means a commitment by a court pursuant 20
to the provisions of this chapter; 21
(34) "Legal counsel" means attorneys and staff employed by county 22
prosecutor offices or the state attorney general acting in their 23
capacity as legal representatives of public behavioral health service 24
providers under RCW 71.05.130; 25
(35) "Less restrictive alternative treatment" means a program of 26
individualized treatment in a less restrictive setting than inpatient 27
treatment that includes the services described in RCW 71.05.585. This 28
term includes: Treatment pursuant to a less restrictive alternative 29
treatment order under RCW 71.05.240 or 71.05.320; treatment pursuant 30
to a conditional release under RCW 71.05.340; and treatment pursuant 31
to an assisted outpatient treatment order under RCW 71.05.148;32
(36) "Licensed physician" means a person licensed to practice 33
medicine or osteopathic medicine and surgery in the state of 34
Washington; 35
(37) "Likelihood of serious harm" means: 36
(a) A substantial risk that: (i) Physical harm will be inflicted 37
by a person upon his or her own person, as evidenced by threats or 38
attempts to commit suicide or inflict physical harm on oneself; (ii) 39
physical harm will be inflicted by a person upon another, as 40
p. 167 HB 2127
evidenced by behavior which has caused harm, substantial pain, or 1
which places another person or persons in reasonable fear of harm to 2
themselves or others; or (iii) physical harm will be inflicted by a 3
person upon the property of others, as evidenced by behavior which 4
has caused substantial loss or damage to the property of others; or5
(b) The person has threatened the physical safety of another and 6
has a history of one or more violent acts; 7
(38) "Medical clearance" means a physician or other health care 8
provider, including an Indian health care provider, has determined 9
that a person is medically stable and ready for referral to the 10
designated crisis responder or facility. For a person presenting in 11
the community, no medical clearance is required prior to 12
investigation by a designated crisis responder; 13
(39) "Mental disorder" means any organic, mental, or emotional 14
impairment which has substantial adverse effects on a person's 15
cognitive or volitional functions; 16
(40) "Mental health professional" means an individual practicing 17
within the mental health professional's statutory scope of practice 18
who is: 19
(a) A psychiatrist, psychologist, physician ((assistant)) 20
associate working with a psychiatrist who is acting as a 21
participating physician as defined in RCW 18.71A.010, psychiatric 22
advanced registered nurse practitioner, psychiatric nurse, or social 23
worker, as defined in this chapter and chapter 71.34 RCW;24
(b) A mental health counselor, mental health counselor associate, 25
marriage and family therapist, or marriage and family therapist 26
associate, as defined in chapter 18.225 RCW; 27
(c) A certified or licensed agency affiliated counselor, as 28
defined in chapter 18.19 RCW; or 29
(d) A licensed psychological associate as described in chapter 30
18.83 RCW; 31
(41) "Peace officer" means a law enforcement official of a public 32
agency or governmental unit, and includes persons specifically given 33
peace officer powers by any state law, local ordinance, or judicial 34
order of appointment; 35
(42) "Physician ((assistant)) associate" means a person licensed 36
as a physician ((assistant)) associate under chapter 18.71A RCW;37
(43) "Private agency" means any person, partnership, corporation, 38
or association that is not a public agency, whether or not financed 39
in whole or in part by public funds, which constitutes an evaluation 40
p. 168 HB 2127
and treatment facility or private institution, or hospital, or 1
approved substance use disorder treatment program, which is conducted 2
for, or includes a department or ward conducted for, the care and 3
treatment of persons with behavioral health disorders;4
(44) "Professional person" means a mental health professional, 5
substance use disorder professional, or designated crisis responder 6
and shall also mean a physician, physician ((assistant)) associate, 7
psychiatric advanced registered nurse practitioner, registered nurse, 8
and such others as may be defined by rules adopted by the secretary 9
pursuant to the provisions of this chapter; 10
(45) "Psychiatric advanced registered nurse practitioner" means a 11
person who is licensed as an advanced practice registered nurse 12
((practitioner)) pursuant to chapter 18.79 RCW; and who is board 13
certified in advanced practice psychiatric and mental health nursing;14
(46) "Psychiatrist" means a person having a license as a 15
physician and surgeon in this state who has in addition completed 16
three years of graduate training in psychiatry in a program approved 17
by the American medical association or the American osteopathic 18
association and is certified or eligible to be certified by the 19
American board of psychiatry and neurology; 20
(47) "Psychologist" means a person who has been licensed as a 21
psychologist pursuant to chapter 18.83 RCW; 22
(48) "Public agency" means any evaluation and treatment facility 23
or institution, secure withdrawal management and stabilization 24
facility, approved substance use disorder treatment program, or 25
hospital which is conducted for, or includes a department or ward 26
conducted for, the care and treatment of persons with behavioral 27
health disorders, if the agency is operated directly by federal, 28
state, county, or municipal government, or a combination of such 29
governments; 30
(49) "Release" means legal termination of the commitment under 31
the provisions of this chapter; 32
(50) "Resource management services" has the meaning given in 33
chapter 71.24 RCW; 34
(51) "Secretary" means the secretary of the department of health, 35
or his or her designee; 36
(52) "Secure withdrawal management and stabilization facility" 37
means a facility operated by either a public or private agency or by 38
the program of an agency which provides care to voluntary individuals 39
and individuals involuntarily detained and committed under this 40
p. 169 HB 2127
chapter for whom there is a likelihood of serious harm or who are 1
gravely disabled due to the presence of a substance use disorder. 2
Secure withdrawal management and stabilization facilities must:3
(a) Provide the following services: 4
(i) Assessment and treatment, provided by certified substance use 5
disorder professionals or co-occurring disorder specialists;6
(ii) Clinical stabilization services; 7
(iii) Acute or subacute detoxification services for intoxicated 8
individuals; and 9
(iv) Discharge assistance provided by certified substance use 10
disorder professionals or co-occurring disorder specialists, 11
including facilitating transitions to appropriate voluntary or 12
involuntary inpatient services or to less restrictive alternatives as 13
appropriate for the individual; 14
(b) Include security measures sufficient to protect the patients, 15
staff, and community; and 16
(c) Be licensed or certified as such by the department of health;17
(53) "Severe deterioration from safe behavior" means that a 18
person will, if not treated, suffer or continue to suffer severe and 19
abnormal mental, emotional, or physical distress, and this distress 20
is associated with significant impairment of judgment, reason, or 21
behavior; 22
(54) "Social worker" means a person with a master's or further 23
advanced degree from a social work educational program accredited and 24
approved as provided in RCW 18.320.010; 25
(55) "State facility" means: 26
(a) The center for behavioral health and learning located on the 27
University of Washington medical center northwest campus; and28
(b) Facilities owned or operated by the department of social and 29
health services that are not state hospitals that provide inpatient 30
services to individuals under this chapter; 31
(56) "State hospital" means a hospital designated under RCW 32
72.23.020; 33
(57) "Substance use disorder" means a cluster of cognitive, 34
behavioral, and physiological symptoms indicating that an individual 35
continues using the substance despite significant substance-related 36
problems. The diagnosis of a substance use disorder is based on a 37
pathological pattern of behaviors related to the use of the 38
substances; 39
p. 170 HB 2127
(58) "Substance use disorder professional" means a person 1
certified as a substance use disorder professional by the department 2
of health under chapter 18.205 RCW; 3
(59) "Therapeutic court personnel" means the staff of a mental 4
health court or other therapeutic court which has jurisdiction over 5
defendants who are dually diagnosed with mental disorders, including 6
court personnel, probation officers, a court monitor, prosecuting 7
attorney, or defense counsel acting within the scope of therapeutic 8
court duties; 9
(60) "Treatment records" include registration and all other 10
records concerning persons who are receiving or who at any time have 11
received services for behavioral health disorders, which are 12
maintained by the department of social and health services, the 13
department, the authority, behavioral health administrative services 14
organizations and their staffs, managed care organizations and their 15
staffs, and by treatment facilities. Treatment records include mental 16
health information contained in a medical bill including but not 17
limited to mental health drugs, a mental health diagnosis, provider 18
name, and dates of service stemming from a medical service. Treatment 19
records do not include notes or records maintained for personal use 20
by a person providing treatment services for the department of social 21
and health services, the department, the authority, behavioral health 22
administrative services organizations, managed care organizations, or 23
a treatment facility if the notes or records are not available to 24
others; 25
(61) "Tribe" has the same meaning as in RCW 71.24.025;26
(62) "Video," unless the context clearly indicates otherwise, 27
means the delivery of behavioral health services through the use of 28
interactive audio and video technology, permitting real-time 29
communication between a person and a designated crisis responder, for 30
the purpose of evaluation. "Video" does not include the use of audio-31
only telephone, facsimile, email, or store and forward technology. 32
"Store and forward technology" means use of an asynchronous 33
transmission of a person's medical information from a mental health 34
service provider to the designated crisis responder which results in 35
medical diagnosis, consultation, or treatment; 36
(63) "Violent act" means behavior that resulted in homicide, 37
attempted suicide, injury, or substantial loss or damage to property.38
p. 171 HB 2127
Sec. 103. RCW 71.05.148 and 2025 c 58 s 5145 are each amended to 1
read as follows: 2
(1) A person is in need of assisted outpatient treatment if the 3
court finds by clear, cogent, and convincing evidence pursuant to a 4
petition filed under this section that: 5
(a) The person has a behavioral health disorder;6
(b) Based on a clinical determination and in view of the person's 7
treatment history and current behavior, at least one of the following 8
is true: 9
(i) The person is unlikely to survive safely in the community 10
without supervision and the person's condition is substantially 11
deteriorating; or 12
(ii) The person is in need of assisted outpatient treatment in 13
order to prevent a relapse or deterioration that would be likely to 14
result in grave disability or a likelihood of serious harm to the 15
person or to others; 16
(c) The person has a history of lack of compliance with treatment 17
for his or her behavioral health disorder that has:18
(i) At least twice within the 36 months prior to the filing of 19
the petition been a significant factor in necessitating 20
hospitalization of the person, or the person's receipt of services in 21
a forensic or other mental health unit of a state or tribal 22
correctional facility or local correctional facility, provided that 23
the 36-month period shall be extended by the length of any 24
hospitalization or incarceration of the person that occurred within 25
the 36-month period; 26
(ii) At least twice within the 36 months prior to the filing of 27
the petition been a significant factor in necessitating emergency 28
medical care or hospitalization for behavioral health-related medical 29
conditions including overdose, infected abscesses, sepsis, 30
endocarditis, or other maladies, or a significant factor in behavior 31
which resulted in the person's incarceration in a state, tribal, or 32
local correctional facility; or 33
(iii) Resulted in one or more violent acts, threats, or attempts 34
to cause serious physical harm to the person or another within the 48 35
months prior to the filing of the petition, provided that the 48-36
month period shall be extended by the length of any hospitalization 37
or incarceration of the person that occurred during the 48-month 38
period; 39
p. 172 HB 2127
(d) Participation in an assisted outpatient treatment program 1
would be the least restrictive alternative necessary to ensure the 2
person's recovery and stability; and 3
(e) The person will benefit from assisted outpatient treatment.4
(2) The following individuals may directly file a petition for 5
less restrictive alternative treatment on the basis that a person is 6
in need of assisted outpatient treatment: 7
(a) The director of a hospital where the person is hospitalized 8
or the director's designee; 9
(b) The director of a behavioral health service provider 10
providing behavioral health care or residential services to the 11
person or the director's designee; 12
(c) The person's treating mental health professional or substance 13
use disorder professional or one who has evaluated the person;14
(d) A designated crisis responder; 15
(e) A release planner from a corrections facility; or16
(f) An emergency room physician. 17
(3) A court order for less restrictive alternative treatment on 18
the basis that the person is in need of assisted outpatient treatment 19
may be effective for up to 18 months. The petitioner must personally 20
interview the person, unless the person refuses an interview, to 21
determine whether the person will voluntarily receive appropriate 22
treatment. 23
(4) The petitioner must allege specific facts based on personal 24
observation, evaluation, or investigation, and must consider the 25
reliability or credibility of any person providing information 26
material to the petition. 27
(5) The petition must include: 28
(a) A statement of the circumstances under which the person's 29
condition was made known and the basis for the opinion, from personal 30
observation or investigation, that the person is in need of assisted 31
outpatient treatment. The petitioner must state which specific facts 32
come from personal observation and specify what other sources of 33
information the petitioner has relied upon to form this belief;34
(b) A declaration from a physician, physician ((assistant)) 35
associate, advanced practice registered nurse, or the person's 36
treating mental health professional or substance use disorder 37
professional, who has examined the person no more than 10 days prior 38
to the submission of the petition and who is willing to testify in 39
support of the petition, or who alternatively has made appropriate 40
p. 173 HB 2127
attempts to examine the person within the same period but has not 1
been successful in obtaining the person's cooperation, and who is 2
willing to testify to the reasons they believe that the person meets 3
the criteria for assisted outpatient treatment. If the declaration is 4
provided by the person's treating mental health professional or 5
substance use disorder professional, it must be cosigned by a 6
supervising physician, physician ((assistant)) associate, or advanced 7
practice registered nurse who certifies that they have reviewed the 8
declaration; 9
(c) The declarations of additional witnesses, if any, supporting 10
the petition for assisted outpatient treatment; 11
(d) The name of an agency, provider, or facility that agrees to 12
provide less restrictive alternative treatment if the petition is 13
granted by the court; and 14
(e) If the person is detained in a state hospital, inpatient 15
treatment facility, jail, or correctional facility at the time the 16
petition is filed, the anticipated release date of the person and any 17
other details needed to facilitate successful reentry and transition 18
into the community. 19
(6)(a) Upon receipt of a petition meeting all requirements of 20
this section, the court shall fix a date for a hearing:21
(i) No sooner than three days or later than seven days after the 22
date of service or as stipulated by the parties or, upon a showing of 23
good cause, no later than 30 days after the date of service; or24
(ii) If the respondent is hospitalized at the time of filing of 25
the petition, before discharge of the respondent and in sufficient 26
time to arrange for a continuous transition from inpatient treatment 27
to assisted outpatient treatment. 28
(b) A copy of the petition and notice of hearing shall be served, 29
in the same manner as a summons, on the petitioner, the respondent, 30
the qualified professional whose affidavit accompanied the petition, 31
a current provider, if any, and a surrogate decision maker or agent 32
under chapter 71.32 RCW, if any. 33
(c) If the respondent has a surrogate decision maker or agent 34
under chapter 71.32 RCW who wishes to provide testimony at the 35
hearing, the court shall afford the surrogate decision maker or agent 36
an opportunity to testify. 37
(d) The respondent shall be represented by counsel at all stages 38
of the proceedings. 39
p. 174 HB 2127
(e) If the respondent fails to appear at the hearing after 1
notice, the court may conduct the hearing in the respondent's 2
absence; provided that the respondent's counsel is present.3
(f) If the respondent has refused to be examined by the qualified 4
professional whose affidavit accompanied the petition, the court may 5
order a mental examination of the respondent. The examination of the 6
respondent may be performed by the qualified professional whose 7
affidavit accompanied the petition. If the examination is performed 8
by another qualified professional, the examining qualified 9
professional shall be authorized to consult with the qualified 10
professional whose affidavit accompanied the petition.11
(g) If the respondent has refused to be examined by a qualified 12
professional and the court finds reasonable grounds to believe that 13
the allegations of the petition are true, the court may issue a 14
written order directing a peace officer who has completed crisis 15
intervention training to detain and transport the respondent to a 16
provider for examination by a qualified professional. A respondent 17
detained pursuant to this subsection shall be detained no longer than 18
necessary to complete the examination and in no event longer than 24 19
hours. 20
(7) If the petition involves a person whom the petitioner or 21
behavioral health administrative services organization knows, or has 22
reason to know, is an American Indian or Alaska Native who receives 23
medical or behavioral health services from a tribe within this state, 24
the petitioner or behavioral health administrative services 25
organization shall notify the tribe and Indian health care provider. 26
Notification shall be made in person or by telephonic or electronic 27
communication to the tribal contact listed in the authority's tribal 28
crisis coordination plan as soon as possible, but before the hearing 29
and no later than 24 hours from the time the petition is served upon 30
the person and the person's guardian. The notice to the tribe or 31
Indian health care provider must include a copy of the petition, 32
together with any orders issued by the court and a notice of the 33
tribe's right to intervene. The court clerk shall provide copies of 34
any court orders necessary for the petitioner or the behavioral 35
health administrative services organization to provide notice to the 36
tribe or Indian health care provider under this section.37
(8) A petition for assisted outpatient treatment filed under this 38
section shall be adjudicated under RCW 71.05.240. 39
p. 175 HB 2127
(9) After January 1, 2023, a petition for assisted outpatient 1
treatment must be filed on forms developed by the administrative 2
office of the courts. 3
Sec. 104. RCW 71.05.154 and 2025 c 58 s 5146 are each amended to 4
read as follows: 5
If a person subject to evaluation under RCW 71.05.150 or 6
71.05.153 is located in an emergency room at the time of evaluation, 7
the designated crisis responder conducting the evaluation shall take 8
serious consideration of observations and opinions by an examining 9
emergency room physician, advanced practice registered nurse, or 10
physician ((assistant)) associate in determining whether detention 11
under this chapter is appropriate. The designated crisis responder 12
must document his or her consultation with this professional, if the 13
professional is available, or his or her review of the professional's 14
written observations or opinions regarding whether detention of the 15
person is appropriate. 16
Sec. 105. RCW 71.05.210 and 2025 c 58 s 5147 are each amended to 17
read as follows: 18
(1) Each person involuntarily detained and accepted or admitted 19
at an evaluation and treatment facility, secure withdrawal management 20
and stabilization facility, or approved substance use disorder 21
treatment program: 22
(a) Shall, within twenty-four hours of his or her admission or 23
acceptance at the facility, not counting time periods prior to 24
medical clearance, be examined and evaluated by: 25
(i) One physician, physician ((assistant)) associate, or advanced 26
practice registered nurse; and 27
(ii) One mental health professional. If the person is detained 28
for substance use disorder evaluation and treatment, the person may 29
be examined by a substance use disorder professional instead of a 30
mental health professional; and 31
(b) Shall receive such treatment and care as his or her condition 32
requires including treatment on an outpatient basis for the period 33
that he or she is detained, except that, beginning twenty-four hours 34
prior to a trial or hearing pursuant to RCW 71.05.215, 71.05.240, 35
71.05.310, 71.05.320, 71.05.590, or 71.05.217, the individual may 36
refuse psychiatric medications, but may not refuse: (i) Any other 37
medication previously prescribed by a person licensed under Title 18 38
p. 176 HB 2127
RCW; or (ii) emergency lifesaving treatment, and the individual shall 1
be informed at an appropriate time of his or her right of such 2
refusal. The person shall be detained up to one hundred twenty hours, 3
if, in the opinion of the professional person in charge of the 4
facility, or his or her professional designee, the person presents a 5
likelihood of serious harm, or is gravely disabled. A person who has 6
been detained for one hundred twenty hours shall no later than the 7
end of such period be released, unless referred for further care on a 8
voluntary basis, or detained pursuant to court order for further 9
treatment as provided in this chapter. 10
(2) If, at any time during the involuntary treatment hold and 11
following the initial examination and evaluation, the mental health 12
professional or substance use disorder professional and licensed 13
physician, physician ((assistant)) associate, or psychiatric advanced 14
practice registered nurse determine that the initial needs of the 15
person, if detained to an evaluation and treatment facility, would be 16
better served by placement in a secure withdrawal management and 17
stabilization facility or approved substance use disorder treatment 18
program, or, if detained to a secure withdrawal management and 19
stabilization facility or approved substance use disorder treatment 20
program, would be better served in an evaluation and treatment 21
facility then the person shall be referred to the more appropriate 22
placement for the remainder of the current commitment period without 23
any need for further court review. 24
(3) An evaluation and treatment center, secure withdrawal 25
management and stabilization facility, or approved substance use 26
disorder treatment program admitting or accepting any person pursuant 27
to this chapter whose physical condition reveals the need for 28
hospitalization shall assure that such person is transferred to an 29
appropriate hospital for evaluation or admission for treatment. 30
Notice of such fact shall be given to the court, the designated 31
attorney, and the designated crisis responder and the court shall 32
order such continuance in proceedings under this chapter as may be 33
necessary, but in no event may this continuance be more than fourteen 34
days. 35
Sec. 106. RCW 71.05.215 and 2025 c 58 s 5148 are each amended to 36
read as follows: 37
(1) A person found to be gravely disabled or to present a 38
likelihood of serious harm as a result of a behavioral health 39
p. 177 HB 2127
disorder has a right to refuse antipsychotic medication unless it is 1
determined that the failure to medicate may result in a likelihood of 2
serious harm or substantial deterioration or substantially prolong 3
the length of involuntary commitment and there is no less intrusive 4
course of treatment than medication in the best interest of that 5
person. 6
(2) The authority shall adopt rules to carry out the purposes of 7
this chapter. These rules shall include: 8
(a) An attempt to obtain the informed consent of the person prior 9
to administration of antipsychotic medication. 10
(b) For short-term treatment up to thirty days, the right to 11
refuse antipsychotic medications unless there is an additional 12
concurring medical opinion approving medication by a psychiatrist, 13
physician ((assistant)) associate working with a psychiatrist who is 14
acting as a participating physician as defined in RCW 18.71A.010, 15
psychiatric advanced practice registered nurse, or physician or 16
physician ((assistant)) associate in consultation with a mental 17
health professional with prescriptive authority. 18
(c) For continued treatment beyond thirty days through the 19
hearing on any petition filed under RCW 71.05.217, the right to 20
periodic review of the decision to medicate by the medical director 21
or designee. 22
(d) Administration of antipsychotic medication in an emergency 23
and review of this decision within twenty-four hours. An emergency 24
exists if the person presents an imminent likelihood of serious harm, 25
and medically acceptable alternatives to administration of 26
antipsychotic medications are not available or are unlikely to be 27
successful; and in the opinion of the physician, physician 28
((assistant)) associate, or psychiatric advanced practice registered 29
nurse, the person's condition constitutes an emergency requiring the 30
treatment be instituted prior to obtaining a second medical opinion.31
(e) Documentation in the medical record of the attempt by the 32
physician, physician ((assistant)) associate, or psychiatric advanced 33
practice registered nurse to obtain informed consent and the reasons 34
why antipsychotic medication is being administered over the person's 35
objection or lack of consent. 36
Sec. 107. RCW 71.05.217 and 2025 c 58 s 5149 are each amended to 37
read as follows: 38
p. 178 HB 2127
(1) Insofar as danger to the individual or others is not created, 1
each person involuntarily detained, treated in a less restrictive 2
alternative course of treatment, or committed for treatment and 3
evaluation pursuant to this chapter shall have, in addition to other 4
rights not specifically withheld by law, the following rights, a list 5
of which shall be prominently posted in all facilities, institutions, 6
and hospitals providing such services: 7
(a) To wear his or her own clothes and to keep and use his or her 8
own personal possessions, except when deprivation of same is 9
essential to protect the safety of the resident or other persons;10
(b) To keep and be allowed to spend a reasonable sum of his or 11
her own money for canteen expenses and small purchases;12
(c) To have access to individual storage space for his or her 13
private use; 14
(d) To have visitors at reasonable times; 15
(e) To have reasonable access to a telephone, both to make and 16
receive confidential calls; 17
(f) To have ready access to letter writing materials, including 18
stamps, and to send and receive uncensored correspondence through the 19
mails; 20
(g) To have the right to individualized care and adequate 21
treatment; 22
(h) To discuss treatment plans and decisions with professional 23
persons; 24
(i) To not be denied access to treatment by spiritual means 25
through prayer in accordance with the tenets and practices of a 26
church or religious denomination in addition to the treatment 27
otherwise proposed; 28
(j) Not to consent to the administration of antipsychotic 29
medications beyond the hearing conducted pursuant to RCW 71.05.320(4) 30
or the performance of electroconvulsant therapy or surgery, except 31
emergency lifesaving surgery, unless ordered by a court of competent 32
jurisdiction pursuant to the following standards and procedures:33
(i) The administration of antipsychotic medication or 34
electroconvulsant therapy shall not be ordered unless the petitioning 35
party proves by clear, cogent, and convincing evidence that there 36
exists a compelling state interest that justifies overriding the 37
patient's lack of consent to the administration of antipsychotic 38
medications or electroconvulsant therapy, that the proposed treatment 39
is necessary and effective, and that medically acceptable alternative 40
p. 179 HB 2127
forms of treatment are not available, have not been successful, or 1
are not likely to be effective. 2
(ii) The court shall make specific findings of fact concerning: 3
(A) The existence of one or more compelling state interests; (B) the 4
necessity and effectiveness of the treatment; and (C) the person's 5
desires regarding the proposed treatment. If the patient is unable to 6
make a rational and informed decision about consenting to or refusing 7
the proposed treatment, the court shall make a substituted judgment 8
for the patient as if he or she were competent to make such a 9
determination. 10
(iii) The person shall be present at any hearing on a request to 11
administer antipsychotic medication or electroconvulsant therapy 12
filed pursuant to this subsection. The person has the right: (A) To 13
be represented by an attorney; (B) to present evidence; (C) to cross-14
examine witnesses; (D) to have the rules of evidence enforced; (E) to 15
remain silent; (F) to view and copy all petitions and reports in the 16
court file; and (G) to be given reasonable notice and an opportunity 17
to prepare for the hearing. The court may appoint a psychiatrist, 18
physician ((assistant)) associate working with a psychiatrist who is 19
acting as a participating physician as defined in RCW 18.71A.010, 20
psychiatric advanced practice registered nurse, psychologist within 21
their scope of practice, physician ((assistant)) associate, or 22
physician to examine and testify on behalf of such person. The court 23
shall appoint a psychiatrist, physician ((assistant)) associate 24
working with a psychiatrist who is acting as a participating 25
physician as defined in RCW 18.71A.010, psychiatric advanced practice 26
registered nurse, psychologist within their scope of practice, 27
physician ((assistant)) associate, or physician designated by such 28
person or the person's counsel to testify on behalf of the person in 29
cases where an order for electroconvulsant therapy is sought.30
(iv) An order for the administration of antipsychotic medications 31
entered following a hearing conducted pursuant to this section shall 32
be effective for the period of the current involuntary treatment 33
order, and any interim period during which the person is awaiting 34
trial or hearing on a new petition for involuntary treatment or 35
involuntary medication. 36
(v) Any person detained pursuant to RCW 71.05.320(4), who 37
subsequently refuses antipsychotic medication, shall be entitled to 38
the procedures set forth in this subsection. 39
p. 180 HB 2127
(vi) Antipsychotic medication may be administered to a 1
nonconsenting person detained or committed pursuant to this chapter 2
without a court order pursuant to RCW 71.05.215(2) or under the 3
following circumstances: 4
(A) A person presents an imminent likelihood of serious harm;5
(B) Medically acceptable alternatives to administration of 6
antipsychotic medications are not available, have not been 7
successful, or are not likely to be effective; and 8
(C)(I) In the opinion of the physician, physician ((assistant)) 9
associate, or psychiatric advanced practice registered nurse with 10
responsibility for treatment of the person, or his or her designee, 11
the person's condition constitutes an emergency requiring the 12
treatment be instituted before a judicial hearing as authorized 13
pursuant to this section can be held. 14
(II) If antipsychotic medications are administered over a 15
person's lack of consent pursuant to this subsection, a petition for 16
an order authorizing the administration of antipsychotic medications 17
shall be filed on the next judicial day. The hearing shall be held 18
within two judicial days. If deemed necessary by the physician, 19
physician ((assistant)) associate, or psychiatric advanced practice 20
registered nurse with responsibility for the treatment of the person, 21
administration of antipsychotic medications may continue until the 22
hearing is held; 23
(k) To dispose of property and sign contracts unless such person 24
has been adjudicated an incompetent in a court proceeding directed to 25
that particular issue; 26
(l) Not to have psychosurgery performed on him or her under any 27
circumstances; 28
(m) To not be denied access to treatment by cultural or spiritual 29
means through practices that are in accordance with a tribal or 30
cultural tradition in addition to the treatment otherwise proposed.31
(2) Every person involuntarily detained or committed under the 32
provisions of this chapter is entitled to all the rights set forth in 33
this chapter and retains all rights not denied him or her under this 34
chapter except as limited by chapter 9.41 RCW. 35
(3) No person may be presumed incompetent as a consequence of 36
receiving evaluation or treatment for a behavioral health disorder. 37
Competency may not be determined or withdrawn except under the 38
provisions of chapter 10.77 RCW. 39
p. 181 HB 2127
(4) Subject to RCW 71.05.745 and related regulations, persons 1
receiving evaluation or treatment under this chapter must be given a 2
reasonable choice of an available physician, physician ((assistant)) 3
associate, psychiatric advanced practice registered nurse, or other 4
professional person qualified to provide such services.5
(5) Whenever any person is detained under this chapter, the 6
person must be advised that unless the person is released or 7
voluntarily admits himself or herself for treatment within 120 hours 8
of the initial detention, a judicial hearing must be held in a 9
superior court within 120 hours to determine whether there is 10
probable cause to detain the person for up to an additional 14 days 11
based on an allegation that because of a behavioral health disorder 12
the person presents a likelihood of serious harm or is gravely 13
disabled, and that at the probable cause hearing the person has the 14
following rights: 15
(a) To communicate immediately with an attorney; to have an 16
attorney appointed if the person is indigent; and to be told the name 17
and address of the attorney that has been designated;18
(b) To remain silent, and to know that any statement the person 19
makes may be used against him or her; 20
(c) To present evidence on the person's behalf;21
(d) To cross-examine witnesses who testify against him or her;22
(e) To be proceeded against by the rules of evidence;23
(f) To have the court appoint a reasonably available independent 24
professional person to examine the person and testify in the hearing, 25
at public expense unless the person is able to bear the cost;26
(g) To view and copy all petitions and reports in the court file; 27
and 28
(h) To refuse psychiatric medications, including antipsychotic 29
medication beginning 24 hours prior to the probable cause hearing.30
(6) The judicial hearing described in subsection (5) of this 31
section must be held according to the provisions of subsection (5) of 32
this section and rules promulgated by the supreme court.33
(7)(a) Privileges between patients and physicians, physician 34
((assistants)) associates, psychologists, or psychiatric advanced 35
practice registered nurses are deemed waived in proceedings under 36
this chapter relating to the administration of antipsychotic 37
medications. As to other proceedings under this chapter, the 38
privileges are waived when a court of competent jurisdiction in its 39
p. 182 HB 2127
discretion determines that such waiver is necessary to protect either 1
the detained person or the public. 2
(b) The waiver of a privilege under this section is limited to 3
records or testimony relevant to evaluation of the detained person 4
for purposes of a proceeding under this chapter. Upon motion by the 5
detained person or on its own motion, the court shall examine a 6
record or testimony sought by a petitioner to determine whether it is 7
within the scope of the waiver. 8
(c) The record maker may not be required to testify in order to 9
introduce medical or psychological records of the detained person so 10
long as the requirements of RCW 5.45.020 are met except that portions 11
of the record which contain opinions as to the detained person's 12
mental state must be deleted from such records unless the person 13
making such conclusions is available for cross-examination.14
(8) Nothing contained in this chapter prohibits the patient from 15
petitioning by writ of habeas corpus for release. 16
(9) Nothing in this section permits any person to knowingly 17
violate a no-contact order or a condition of an active judgment and 18
sentence or an active condition of supervision by the department of 19
corrections. 20
(10) The rights set forth under this section apply equally to 90-21
day or 180-day hearings under RCW 71.05.310. 22
Sec. 108. RCW 71.05.230 and 2025 c 58 s 5150 are each amended to 23
read as follows: 24
A person detained for one hundred twenty hours of evaluation and 25
treatment may be committed for not more than fourteen additional days 26
of involuntary intensive treatment or ninety additional days of a 27
less restrictive alternative treatment. A petition may only be filed 28
if the following conditions are met: 29
(1) The professional staff of the facility providing evaluation 30
services has analyzed the person's condition and finds that the 31
condition is caused by a behavioral health disorder and results in: 32
(a) A likelihood of serious harm; or (b) the person being gravely 33
disabled; and are prepared to testify those conditions are met; and34
(2) The person has been advised of the need for voluntary 35
treatment and the professional staff of the facility has evidence 36
that he or she has not in good faith volunteered; and37
(3) The facility providing intensive treatment is certified to 38
provide such treatment by the department or under RCW 71.05.745; and39
p. 183 HB 2127
(4)(a)(i) The professional staff of the facility or the 1
designated crisis responder has filed a petition with the court for a 2
fourteen day involuntary detention or a ninety day less restrictive 3
alternative. The petition must be signed by: 4
(A) One physician, physician ((assistant)) associate, or 5
psychiatric advanced practice registered nurse; and6
(B) One physician, physician ((assistant)) associate, psychiatric 7
advanced practice registered nurse, or mental health professional.8
(ii) If the petition is for substance use disorder treatment, the 9
petition may be signed by a substance use disorder professional 10
instead of a mental health professional and by an advanced practice 11
registered nurse instead of a psychiatric advanced practice 12
registered nurse. The persons signing the petition must have examined 13
the person. 14
(b) If involuntary detention is sought the petition shall state 15
facts that support the finding that such person, as a result of a 16
behavioral health disorder, presents a likelihood of serious harm, or 17
is gravely disabled and that there are no less restrictive 18
alternatives to detention in the best interest of such person or 19
others. The petition shall state specifically that less restrictive 20
alternative treatment was considered and specify why treatment less 21
restrictive than detention is not appropriate. If an involuntary less 22
restrictive alternative is sought, the petition shall state facts 23
that support the finding that such person, as a result of a 24
behavioral health disorder, presents a likelihood of serious harm or 25
is gravely disabled and shall set forth any recommendations for less 26
restrictive alternative treatment services; and 27
(5) A copy of the petition has been served on the detained 28
person, his or her attorney, and his or her guardian, if any, prior 29
to the probable cause hearing; and 30
(6) The court at the time the petition was filed and before the 31
probable cause hearing has appointed counsel to represent such person 32
if no other counsel has appeared; and 33
(7) The petition reflects that the person was informed of the 34
loss of firearm rights if involuntarily committed for mental health 35
treatment; and 36
(8) At the conclusion of the initial commitment period, the 37
professional staff of the agency or facility or the designated crisis 38
responder may petition for an additional period of either 90 days of 39
p. 184 HB 2127
less restrictive alternative treatment or 90 days of involuntary 1
intensive treatment as provided in RCW 71.05.290; and2
(9) If the hospital or facility designated to provide less 3
restrictive alternative treatment is other than the facility 4
providing involuntary treatment, the outpatient facility so 5
designated to provide less restrictive alternative treatment has 6
agreed to assume such responsibility. 7
Sec. 109. RCW 71.05.290 and 2025 c 58 s 5151 are each amended to 8
read as follows: 9
(1) At any time during a person's 14-day intensive treatment 10
period, the professional person in charge of a treatment facility or 11
his or her professional designee or the designated crisis responder 12
may petition the superior court for an order requiring such person to 13
undergo an additional period of treatment. Such petition must be 14
based on one or more of the grounds set forth in RCW 71.05.280.15
(2)(a)(i) The petition shall summarize the facts which support 16
the need for further commitment and shall be supported by affidavits 17
based on an examination of the patient and signed by:18
(A) One physician, physician ((assistant)) associate, or 19
psychiatric advanced practice registered nurse; and20
(B) One physician, physician ((assistant)) associate, psychiatric 21
advanced practice registered nurse, or mental health professional.22
(ii) If the petition is for substance use disorder treatment, the 23
petition may be signed by a substance use disorder professional 24
instead of a mental health professional and by an advanced practice 25
registered nurse instead of a psychiatric advanced practice 26
registered nurse. 27
(b) The affidavits shall describe in detail the behavior of the 28
detained person which supports the petition and shall explain what, 29
if any, less restrictive treatments which are alternatives to 30
detention are available to such person, and shall state the 31
willingness of the affiant to testify to such facts in subsequent 32
judicial proceedings under this chapter. If less restrictive 33
alternative treatment is sought, the petition shall set forth any 34
recommendations for less restrictive alternative treatment services.35
(3) If a person has been determined to be incompetent pursuant to 36
RCW 10.77.645(7), then the professional person in charge of the 37
treatment facility or his or her professional designee or the 38
designated crisis responder may directly file a petition for 180-day 39
p. 185 HB 2127
treatment under RCW 71.05.280(3), or for 90-day treatment under RCW 1
71.05.280 (1), (2), or (4). No petition for initial detention or 14-2
day detention is required before such a petition may be filed.3
Sec. 110. RCW 71.05.300 and 2025 c 58 s 5152 are each amended to 4
read as follows: 5
(1) The petition for ninety day treatment shall be filed with the 6
clerk of the superior court at least three days before expiration of 7
the fourteen-day period of intensive treatment. The clerk shall set a 8
trial setting date as provided in RCW 71.05.310 on the next judicial 9
day after the date of filing the petition and notify the designated 10
crisis responder. The designated crisis responder shall immediately 11
notify the person detained, his or her attorney, if any, and his or 12
her guardian or conservator, if any, the prosecuting attorney, and 13
the behavioral health administrative services organization 14
administrator, and provide a copy of the petition to such persons as 15
soon as possible. The behavioral health administrative services 16
organization administrator or designee may review the petition and 17
may appear and testify at the full hearing on the petition.18
(2) The attorney for the detained person shall advise him or her 19
of his or her right to be represented by an attorney, his or her 20
right to a jury trial, and, if the petition is for commitment for 21
mental health treatment, his or her loss of firearm rights if 22
involuntarily committed. If the detained person is not represented by 23
an attorney, or is indigent or is unwilling to retain an attorney, 24
the court shall immediately appoint an attorney to represent him or 25
her. The court shall, if requested, appoint a reasonably available 26
licensed physician, physician ((assistant)) associate, psychiatric 27
advanced practice registered nurse, psychologist, psychiatrist, or 28
other professional person, designated by the detained person to 29
examine and testify on behalf of the detained person.30
(3) The court may, if requested, also appoint a professional 31
person as defined in RCW 71.05.020 to seek less restrictive 32
alternative courses of treatment and to testify on behalf of the 33
detained person. In the case of a person with a developmental 34
disability who has been determined to be incompetent pursuant to RCW 35
10.77.645(7), the appointed professional person under this section 36
shall be a developmental disabilities professional.37
p. 186 HB 2127
Sec. 111. RCW 71.05.585 and 2025 c 58 s 5153 are each amended to 1
read as follows: 2
(1) Less restrictive alternative treatment, at a minimum, 3
includes the following services: 4
(a) Assignment of a care coordinator; 5
(b) An intake evaluation with the provider of the less 6
restrictive alternative treatment; 7
(c) A psychiatric evaluation, a substance use disorder 8
evaluation, or both; 9
(d) A schedule of regular contacts with the provider of the 10
treatment services for the duration of the order; 11
(e) A transition plan addressing access to continued services at 12
the expiration of the order; 13
(f) An individual crisis plan; 14
(g) Consultation about the formation of a mental health advance 15
directive under chapter 71.32 RCW; and 16
(h) Notification to the care coordinator assigned in (a) of this 17
subsection if reasonable efforts to engage the client fail to produce 18
substantial compliance with court-ordered treatment conditions.19
(2) Less restrictive alternative treatment may additionally 20
include requirements to participate in the following services:21
(a) Medication management; 22
(b) Psychotherapy; 23
(c) Nursing; 24
(d) Substance use disorder counseling; 25
(e) Residential treatment; 26
(f) Partial hospitalization; 27
(g) Intensive outpatient treatment; 28
(h) Support for housing, benefits, education, and employment; and29
(i) Periodic court review. 30
(3) If the person was provided with involuntary medication under 31
RCW 71.05.215 or pursuant to a judicial order during the involuntary 32
commitment period, the less restrictive alternative treatment order 33
may authorize the less restrictive alternative treatment provider or 34
its designee to administer involuntary antipsychotic medication to 35
the person if the provider has attempted and failed to obtain the 36
informed consent of the person and there is a concurring medical 37
opinion approving the medication by a psychiatrist, physician 38
((assistant)) associate working with a psychiatrist who is acting as 39
a participating physician as defined in RCW 18.71A.010, psychiatric 40
p. 187 HB 2127
advanced practice registered nurse, or physician or physician 1
((assistant)) associate in consultation with an independent mental 2
health professional with prescribing authority. 3
(4) Less restrictive alternative treatment must be administered 4
by a provider that is certified or licensed to provide or coordinate 5
the full scope of services required under the less restrictive 6
alternative order and that has agreed to assume this responsibility.7
(5) The care coordinator assigned to a person ordered to less 8
restrictive alternative treatment must submit an individualized plan 9
for the person's treatment services to the court that entered the 10
order. An initial plan must be submitted as soon as possible 11
following the intake evaluation and a revised plan must be submitted 12
upon any subsequent modification in which a type of service is 13
removed from or added to the treatment plan. 14
(6) A care coordinator may disclose information and records 15
related to mental health services pursuant to RCW 70.02.230(2)(k) for 16
purposes of implementing less restrictive alternative treatment.17
(7) For the purpose of this section, "care coordinator" means a 18
clinical practitioner who coordinates the activities of less 19
restrictive alternative treatment. The care coordinator coordinates 20
activities with the designated crisis responders that are necessary 21
for enforcement and continuation of less restrictive alternative 22
orders and is responsible for coordinating service activities with 23
other agencies and establishing and maintaining a therapeutic 24
relationship with the individual on a continuing basis.25
Sec. 112. RCW 71.05.660 and 2016 sp.s. c 29 s 420 and 2016 c 155 26
s 9 are each reenacted and amended to read as follows:27
Nothing in this chapter or chapter 70.02 or 71.34 RCW shall be 28
construed to interfere with communications between physicians, 29
physician ((assistants)) associates, psychiatric advanced registered 30
nurse practitioners, or psychologists and patients and attorneys and 31
clients. 32
Sec. 113. RCW 71.06.040 and 2016 c 155 s 10 are each amended to 33
read as follows: 34
At a preliminary hearing upon the charge of sexual psychopathy, 35
the court may require the testimony of two duly licensed physicians, 36
physician ((assistants)) associates, or psychiatric advanced 37
registered nurse practitioners who have examined the defendant. If 38
p. 188 HB 2127
the court finds that there are reasonable grounds to believe the 1
defendant is a sexual psychopath, the court shall order said 2
defendant confined at the nearest state hospital for observation as 3
to the existence of sexual psychopathy. Such observation shall be for 4
a period of not to exceed ninety days. The defendant shall be 5
detained in the county jail or other county facilities pending 6
execution of such observation order by the department.7
Sec. 114. RCW 71.12.540 and 2025 c 58 s 5154 are each amended to 8
read as follows: 9
The authorities of each establishment as defined in this chapter 10
shall place on file in the office of the establishment the 11
recommendations made by the department of health as a result of such 12
visits, for the purpose of consultation by such authorities, and for 13
reference by the department representatives upon their visits. Every 14
such establishment shall keep records of every person admitted 15
thereto as follows and shall furnish to the department, when 16
required, the following data: Name, age, sex, marital status, date of 17
admission, voluntary or other commitment, name of physician, 18
physician ((assistant)) associate, or psychiatric advanced practice 19
registered nurse, diagnosis, and date of discharge.20
Sec. 115. 2021 c 170 s 1 (uncodified) is amended to read as 21
follows: 22
The legislature finds that there is a compelling and urgent need 23
for coordinated investments in the state's behavioral health 24
workforce. The demand for a qualified behavioral health workforce 25
continues to grow as the availability of services throughout the 26
state does not meet the need. According to the workforce training and 27
education coordinating board's "behavioral health workforce: Barriers 28
and solutions report," Washington ranks 31 out of the 50 states when 29
comparing prevalence of mental illness to access to care. In 30
addition, behavioral health needs have increased since the COVID-19 31
pandemic began and the need is expected to rise as economic and 32
social hardships continue. Despite increased demand, the legislature 33
finds that there continues to be difficulties in recruiting and 34
retaining professionals who are adequately trained to meet behavioral 35
health needs. Many of these professions require years of training, 36
ranging from some postsecondary education to medical degrees. In 37
addition, the legislature finds that there is significant variation 38
p. 189 HB 2127
in the geographic distribution of behavioral health providers across 1
the state. Rural and underserved areas face disparities in access to 2
care. High student loan debt loads, better pay, and lighter caseloads 3
can drive behavioral health professionals into private practice or 4
hospital-based settings rather than community-based settings which 5
typically have a higher percentage of medicaid-funded services and 6
higher caseloads. 7
The legislature finds that there are professions and areas within 8
the behavioral health workforce that are most in need of state 9
investment. The legislature intends to focus coordinated efforts and 10
investments on these areas of greatest need including, but not 11
limited to: 12
(1) Behavioral health apprenticeships; 13
(2) Children's mental health professionals; 14
(3) Peer counselors; 15
(4) Crisis hotline agents; 16
(5) Behavioral health residencies for professionals such as 17
psychiatrists, advanced registered nurse practitioners, physician 18
((assistants)) associates, and pharmacists; 19
(6) Substance use disorder professionals; 20
(7) Community mental health workers; 21
(8) Clinical social workers; 22
(9) Licensed mental health counselors; 23
(10) Licensed marriage and family therapists; and24
(11) Clinical psychologists. 25
The legislature also recognizes existing programs that have 26
helped recruit, retain, and grow the behavioral health workforce, 27
such as the Washington health corps, which provides loan repayment to 28
behavioral health professionals, and the Washington state opportunity 29
scholarship, which utilizes a public-private match to fund 30
scholarships for students pursing health fields. Therefore, the 31
legislature intends to increase the behavioral health workforce by 32
expanding on successful existing programs, establishing new ones, and 33
by focusing the efforts of the workforce education investment act.34
Sec. 116. RCW 71.32.110 and 2025 c 58 s 5156 are each amended to 35
read as follows: 36
(1) For the purposes of this chapter, a principal, agent, 37
professional person, or health care provider may seek a determination 38
whether the principal is incapacitated or has regained capacity.39
p. 190 HB 2127
(2)(a) For the purposes of this chapter, no adult may be declared 1
an incapacitated person except by: 2
(i) A court, if the request is made by the principal or the 3
principal's agent; 4
(ii) One mental health professional or substance use disorder 5
professional and one health care provider; or 6
(iii) Two health care providers. 7
(b) One of the persons making the determination under (a)(ii) or 8
(iii) of this subsection must be a psychiatrist, physician 9
((assistant)) associate working with a psychiatrist who is acting as 10
a participating physician as defined in RCW 18.71A.010, psychologist, 11
or a psychiatric advanced practice registered nurse.12
(3) When a professional person or health care provider requests a 13
capacity determination, he or she shall promptly inform the principal 14
that: 15
(a) A request for capacity determination has been made; and16
(b) The principal may request that the determination be made by a 17
court. 18
(4) At least one mental health professional, substance use 19
disorder professional, or health care provider must personally 20
examine the principal prior to making a capacity determination.21
(5)(a) When a court makes a determination whether a principal has 22
capacity, the court shall, at a minimum, be informed by the testimony 23
of one mental health professional or substance use disorder 24
professional familiar with the principal and shall, except for good 25
cause, give the principal an opportunity to appear in court prior to 26
the court making its determination. 27
(b) To the extent that local court rules permit, any party or 28
witness may testify telephonically. 29
(6) When a court has made a determination regarding a principal's 30
capacity and there is a subsequent change in the principal's 31
condition, subsequent determinations whether the principal is 32
incapacitated may be made in accordance with any of the provisions of 33
subsection (2) of this section. 34
Sec. 117. RCW 71.32.140 and 2025 c 58 s 5157 are each amended to 35
read as follows: 36
(1) A principal who: 37
(a) Chose not to be able to revoke his or her directive during 38
any period of incapacity; 39
p. 191 HB 2127
(b) Consented to voluntary admission to inpatient behavioral 1
health treatment, or authorized an agent to consent on the 2
principal's behalf; and 3
(c) At the time of admission to inpatient treatment, refuses to 4
be admitted, may only be admitted into inpatient behavioral health 5
treatment under subsection (2) of this section. 6
(2) A principal may only be admitted to inpatient behavioral 7
health treatment under his or her directive if, prior to admission, a 8
member of the treating facility's professional staff who is a 9
physician, physician ((assistant)) associate, or psychiatric advanced 10
practice registered nurse: 11
(a) Evaluates the principal's mental condition, including a 12
review of reasonably available psychiatric and psychological history, 13
diagnosis, and treatment needs, and determines, in conjunction with 14
another health care provider, mental health professional, or 15
substance use disorder professional, that the principal is 16
incapacitated; 17
(b) Obtains the informed consent of the agent, if any, designated 18
in the directive; 19
(c) Makes a written determination that the principal needs an 20
inpatient evaluation or is in need of inpatient treatment and that 21
the evaluation or treatment cannot be accomplished in a less 22
restrictive setting; and 23
(d) Documents in the principal's medical record a summary of the 24
physician's, physician ((assistant's)) associate's, or psychiatric 25
advanced practice registered nurse's findings and recommendations for 26
treatment or evaluation. 27
(3) In the event the admitting physician is not a psychiatrist, 28
the admitting physician ((assistant)) associate is not working with a 29
psychiatrist who is acting as a participating physician as defined in 30
RCW 18.71A.010, or the advanced practice registered nurse is not a 31
psychiatric advanced practice registered nurse, the principal shall 32
receive a complete behavioral health assessment by a mental health 33
professional or substance use disorder professional within 24 hours 34
of admission to determine the continued need for inpatient evaluation 35
or treatment. 36
(4)(a) If it is determined that the principal has capacity, then 37
the principal may only be admitted to, or remain in, inpatient 38
treatment if he or she consents at the time, is admitted for family-39
p. 192 HB 2127
initiated treatment under chapter 71.34 RCW, or is detained under the 1
involuntary treatment provisions of chapter 71.05 or 71.34 RCW.2
(b) If a principal who is determined by two health care providers 3
or one mental health professional or substance use disorder 4
professional and one health care provider to be incapacitated 5
continues to refuse inpatient treatment, the principal may 6
immediately seek injunctive relief for release from the facility.7
(5) If, at the end of the period of time that the principal or 8
the principal's agent, if any, has consented to voluntary inpatient 9
treatment, but no more than 14 days after admission, the principal 10
has not regained capacity or has regained capacity but refuses to 11
consent to remain for additional treatment, the principal must be 12
released during reasonable daylight hours, unless detained under 13
chapter 71.05 or 71.34 RCW. 14
(6)(a) Except as provided in (b) of this subsection, any 15
principal who is voluntarily admitted to inpatient behavioral health 16
treatment under this chapter shall have all the rights provided to 17
individuals who are voluntarily admitted to inpatient treatment under 18
chapter 71.05, 71.34, or 72.23 RCW. 19
(b) Notwithstanding RCW 71.05.050 regarding consent to inpatient 20
treatment for a specified length of time, the choices an 21
incapacitated principal expressed in his or her directive shall 22
control, provided, however, that a principal who takes action 23
demonstrating a desire to be discharged, in addition to making 24
statements requesting to be discharged, shall be discharged, and no 25
principal shall be restrained in any way in order to prevent his or 26
her discharge. Nothing in this subsection shall be construed to 27
prevent detention and evaluation for civil commitment under chapter 28
71.05 RCW. 29
(7) Consent to inpatient admission in a directive is effective 30
only while the professional person, health care provider, and health 31
care facility are in substantial compliance with the material 32
provisions of the directive related to inpatient treatment.33
Sec. 118. RCW 71.32.250 and 2025 c 58 s 5158 are each amended to 34
read as follows: 35
(1) If a principal who is a resident of a long-term care facility 36
is admitted to inpatient behavioral health treatment pursuant to his 37
or her directive, the principal shall be allowed to be readmitted to 38
the same long-term care facility as if his or her inpatient admission 39
p. 193 HB 2127
had been for a physical condition on the same basis that the 1
principal would be readmitted under state or federal statute or rule 2
when: 3
(a) The treating facility's professional staff determine that 4
inpatient behavioral health treatment is no longer medically 5
necessary for the resident. The determination shall be made in 6
writing by a psychiatrist, physician ((assistant)) associate working 7
with a psychiatrist who is acting as a participating physician as 8
defined in RCW 18.71A.010, or a psychiatric advanced practice 9
registered nurse, or (i) one physician and a mental health 10
professional or substance use disorder professional; (ii) one 11
physician ((assistant)) associate and a mental health professional or 12
substance use disorder professional; or (iii) one psychiatric 13
advanced practice registered nurse and a mental health professional 14
or substance use disorder professional; or 15
(b) The person's consent to admission in his or her directive has 16
expired. 17
(2)(a) If the long-term care facility does not have a bed 18
available at the time of discharge, the treating facility may 19
discharge the resident, in consultation with the resident and agent 20
if any, and in accordance with a medically appropriate discharge 21
plan, to another long-term care facility. 22
(b) This section shall apply to inpatient behavioral health 23
treatment admission of long-term care facility residents, regardless 24
of whether the admission is directly from a facility, hospital 25
emergency room, or other location. 26
(c) This section does not restrict the right of the resident to 27
an earlier release from the inpatient treatment facility. This 28
section does not restrict the right of a long-term care facility to 29
initiate transfer or discharge of a resident who is readmitted 30
pursuant to this section, provided that the facility has complied 31
with the laws governing the transfer or discharge of a resident.32
(3) The joint legislative audit and review committee shall 33
conduct an evaluation of the operation and impact of this section. 34
The committee shall report its findings to the appropriate committees 35
of the legislature by December 1, 2004. 36
Sec. 119. RCW 71.32.260 and 2025 c 58 s 5159 are each amended to 37
read as follows: 38
The directive shall be in substantially the following form:39
p. 194 HB 2127
1
2
3
Mental Health Advance Directive of (client name)
With Appointment of (agent name) as
Agent for Mental Health Decisions
4
5
6
7
8
9
PART I.
STATEMENT OF INTENT TO CREATE A
MENTAL HEALTH ADV ANCE DIRECTIVE
I, (Client name), being a person with capacity, willfully and voluntarily execute this mental health advance directive so that
my choices regarding my mental health care will be carried out in circumstances when I am unable to express my
instructions and preferences regarding my mental health care.
10
11
12
13
14
15
16
17
PART II.
MY CARE NEEDS – WHAT WORKS FOR ME
In order to assist in carrying out my directive I would like my providers and my agent to know the following information:
I have been diagnosed with (client illnesses both mental health and physical diagnoses) for which I take (list medications).
I am also on the following other medications: (list any other medications for other conditions).
The best treatment method for my illness is (give general overview of what works best for client).
I have/do not have a history of substance abuse. My preferences and treatment options around medication management
related to substance abuse are:
18
19
20
21
22
23
24
PART III.
WHEN THIS DIRECTIVE IS EFFECTIVE
(You must complete this part for your directive to be valid.)
I intend that this directive become effective (YOU MUST CHOOSE ONLY ONE):
. . . . . . Immediately upon my signing of this directive.
. . . . . . If I become incapacitated.
. . . . . . When the following circumstances, symptoms, or behaviors occur:
25
26
27
28
29
30
PART IV .
DURATION OF THIS DIRECTIVE
(You must complete this part for your directive to be valid.)
I want this directive to (YOU MUST CHOOSE ONLY ONE):
. . . . . . Remain valid and in effect for an indefinite period of time.
. . . . . . Automatically expire . . . . . . years from the date it was created.
p. 195 HB 2127
1
2
3
4
5
6
7
8
9
10
11
12
PART V .
WHEN I MAY REVOKE THIS DIRECTIVE
(You must complete this part for this directive to be valid.)
I intend that I be able to revoke this directive (YOU MUST CHOOSE ONLY ONE):
. . . . . . Only when I have capacity.
I understand that choosing this option means I may only revoke this directive if I have capacity. I further understand that if
I choose this option and become incapacitated while this directive is in effect, I may receive treatment that I specify in this
directive, even if I object at the time.
. . . . . . Even if I am incapacitated.
I understand that choosing this option means that I may revoke this directive even if I am incapacitated. I further
understand that if I choose this option and revoke this directive while I am incapacitated I may not receive treatment that I
specify in this directive, even if I want the treatment.
13
14
15
PART VI.
PREFERENCES AND INSTRUCTIONS ABOUT TREATMENT, FACILITIES, AND PHYSICIANS, PHYSICIAN
((ASSISTANTS)) ASSOCIATES, OR ADV ANCED PRACTICE REGISTERED NURSES
16
17
18
19
20
A. Preferences and Instructions About Physician (s), Physician ((Assistant(s))) Associate(s), or Advanced Practice
Registered Nurse(s) to be Involved in My Treatment
I would like the physician (s), physician ((assistant(s))) associate(s), or advanced practice registered nurse (s) named below
to be involved in my treatment decisions:
I do not wish to be treated by
21
22
23
B. Preferences and Instructions About Other Providers
I am receiving other treatment or care from providers who I feel have an impact on my mental health care. I would like the
following treatment provider(s) to be contacted when this directive is effective:
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
C. Preferences and Instructions About Medications for Psychiatric Treatment (check all that apply)
. . . . . . I consent, and authorize my agent (if appointed) to consent, to the following medications:
. . . . . . I do not consent, and I do not authorize my agent (if appointed) to consent, to the administration of the following
medications:
. . . . . . I am willing to take the medications excluded above if my only reason for excluding them is the side effects which
include:
and these side effects can be eliminated by dosage adjustment or other means
. . . . . . I am willing to try any other medication the hospital doctor, physician ((assistant)) associate, or advanced practice
registered nurse recommends.
. . . . . . I am willing to try any other medications my outpatient doctor, physician ((assistant)) associate, or advanced
practice registered nurse recommends.
. . . . . . I do not want to try any other medications.
Medication Allergies.
I have allergies to, or severe side effects from, the following:
Other Medication Preferences or Instructions
. . . . . . I have the following other preferences or instructions about medications:
p. 196 HB 2127
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
D. Preferences and Instructions About Hospitalization and Alternatives
(check all that apply and, if desired, rank "1" for first choice, "2" for second choice, and so on)
. . . . . . In the event my psychiatric condition is serious enough to require 24-hour care and I have no physical conditions
that require immediate access to emergency medical care, I prefer to receive this care in programs/facilities designed as
alternatives to psychiatric hospitalizations.
. . . . . . I would also like the interventions below to be tried before hospitalization is considered:
. . . . . . Calling someone or having someone call me when needed.
Name:. . . . . . . . . . . . . . . . . . . . . . . . . Telephone/text:. . . . . . . . . . . . . . . . . . . . . . . . . Email:. . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . Staying overnight with someone
Name:. . . . . . . . . . . . . . . . . . . . . . . . . Telephone/text:. . . . . . . . . . . . . . . . . . . . . . . . . Email:. . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . Having a mental health service provider come to see me.
. . . . . . Going to a crisis triage center or emergency room.
. . . . . . Staying overnight at a crisis respite (temporary) bed.
. . . . . . Seeing a service provider for help with psychiatric medications.
. . . . . . Other, specify:
16
17
18
Authority to Consent to Inpatient Treatment
I consent, and authorize my agent (if appointed) to consent, to voluntary admission to inpatient mental health treatment
for ...... days (not to exceed 14 days).
19 (Sign one): . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
21
. . . . . . If deemed appropriate by my agent (if appointed) and treating physician, physician ((assistant)) associate, or
advanced practice registered nurse
22
23
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Signature)

24 Or
25
26
. . . . . . Under the following circumstances (specify symptoms, behaviors, or circumstances that indicate the need for
hospitalization)
27
28
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Signature)

29 . . . . . . I do not consent, or authorize my agent (if appointed) to consent, to inpatient treatment
30
31
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Signature)

32
33
34
Hospital Preferences and Instructions
If hospitalization is required, I prefer the following hospitals:
I do not consent to be admitted to the following hospitals:
p. 197 HB 2127
1
2
3
4
5
6
7
8
9
10
11
12
E. Preferences and Instructions About Preemergency
I would like the interventions below to be tried before use of seclusion or restraint is considered (check all that apply):
. . . . . . "Talk me down" one-on-one
. . . . . . More medication
. . . . . . Time out/privacy
. . . . . . Show of authority/force
. . . . . . Shift my attention to something else
. . . . . . Set firm limits on my behavior
. . . . . . Help me to discuss/vent feelings
. . . . . . Decrease stimulation
. . . . . . Offer to have neutral person settle dispute
. . . . . . Other:
13
14
15
16
17
18
19
20
21
22
23
24
25
F. Preferences and Instructions About Seclusion, Restraint, and Emergency Medications
If it is determined that I am engaging in behavior that requires seclusion, physical restraint, and/or emergency use of
medication, I prefer these interventions in the order I have chosen (choose "1" for first choice, "2" for second choice, and so
on):
. . . . . . Seclusion
. . . . . . Seclusion and physical restraint (combined)
. . . . . . Medication by injection
. . . . . . Medication in pill or liquid form
In the event that my attending physician, physician ((assistant)) associate, or advanced practice registered nurse decides to
use medication in response to an emergency situation after due consideration of my preferences and instructions for
emergency treatments stated above, I expect the choice of medication to reflect any preferences and instructions I have
expressed in Part VI C. of this form. The preferences and instructions I express in this section regarding medication in
emergency situations do not constitute consent to use of the medication for nonemergency treatment.
26
27
28
29
G. Preferences and Instructions About Electroconvulsive Therapy
(ECT or Shock Therapy)
My wishes regarding electroconvulsive therapy are (sign one):
. . . . . .I do not consent, nor authorize my agent (if appointed) to consent, to the administration of electroconvulsive therapy
30
31
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Signature)

32 . . . . . . I consent, and authorize my agent (if appointed) to consent, to the administration of electroconvulsive therapy
33
34
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Signature)

35
36
. . . . . . I consent, and authorize my agent (if appointed) to consent, to the administration of electroconvulsive therapy, but
only under the following conditions:
37
38
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Signature)

p. 198 HB 2127
1
2
3

H. Preferences and Instructions About Who is Permitted to Visit
If I have been admitted to a mental health treatment facility, the following people are not permitted to visit me there:
4 Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 I understand that persons not listed above may be permitted to visit me.
7
8
9
I. Additional Instructions About My Mental Health Care
Other instructions about my mental health care:
In case of emergency, please contact:
10
11
12
13
14
Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Work telephone: . . . . . . . . . . . . . . . . . . . . . . . .
Physician, physician ((assistant)) associate, or
advanced practice registered nurse: . . . . . . . . .
Telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Home telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Email: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
16
17
The following may help me to avoid a hospitalization:
I generally react to being hospitalized as follows:
Staff of the hospital or crisis unit can help me by doing the following:
18
19
J. Refusal of Treatment
I do not consent to any mental health treatment.
20
21
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Signature)

22
23
PART VII.
DURABLE POWER OF ATTORNEY (APPOINTMENT OF MY AGENT)
24 (Fill out this part only if you wish to appoint an agent or nominate a guardian.)
25
26
27
28
29
30
31
32
33
34
35
36
37
I authorize an agent to make mental health treatment decisions on my behalf. The authority granted to my agent includes
the right to consent, refuse consent, or withdraw consent to any mental health care, treatment, service, or procedure,
consistent with any instructions and/or limitations I have set forth in this directive. I intend that those decisions should be
made in accordance with my expressed wishes as set forth in this document. If I have not expressed a choice in this
document and my agent does not otherwise know my wishes , I authorize my agent to make the decision that my agent
determines is in my best interest. This agency shall not be affected by my incapacity. Unless I state otherwise in this
durable power of attorney, I may revoke it unless prohibited by other state law.

HIPAA Release Authority. In addition to the other powers granted by this document, I grant to my Attorney-in-Fact the
power and authority to serve as my personal representative for all purposes under the Health Insurance Portability and
Accountability Act (HIPAA) of 1996, as amended from time to time, and its regulations. My Attorney-in-Fact will serve as
my "HIPAA personal representative" and will exercise this authority at any time that my Attorney-in-Fact is exercising
authority under this document.
p. 199 HB 2127
1 A. Designation of an Agent
2 Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Work phone: . . . . . . . . . . . . . . . . . . . . . . . . . . . Home/cell phone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Relationship: . . . . . . . . . . . . . . . . . . . . . . . . . . . Email: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 B. Designation of Alternate Agent
6
7
8
If the person named above is unavailable, unable, or refuses to serve as my agent, or I revoke that person's authority to
serve as my agent, I hereby appoint the following person as my alternate agent and request that this person be notified
immediately when this directive becomes effective or when my original agent is no longer my agent:
9 Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Work phone: . . . . . . . . . . . . . . . . . . . . . . . . . . . Home phone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11 Relationship: . . . . . . . . . . . . . . . . . . . . . . . . . . . Email: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
13
14
15
16
C. Limitations on My Agent's Authority
I do not grant my agent the authority to consent on my behalf to the following:
D. Limitations on My Ability to Revoke this Durable Power of Attorney
I choose to limit my ability to revoke this durable power of attorney as follows:
E. Preference as to Court-Appointed Guardian
17
18
In the event a court appoints a guardian who will make decisions regarding my mental health treatment, I nominate my
then-serving agent (or name someone else) as my guardian:
19 Name and contact information (if someone other than agent or alternate):
20
21
22
The appointment of a guardian of my estate or my person or any other decision maker shall not give the guardian or
decision maker the power to revoke, suspend, or terminate this directive or the powers of my agent, except as authorized by
law.
23
24
25
26

PART VIII.
OTHER DOCUMENTS
27 (Initial all that apply)
28
29
I have executed the following documents that include the power to make decisions regarding health care services for
myself:
30 . . . . . . Health care power of attorney (chapter 11.125 RCW)
31 . . . . . . "Living will" (Health care directive; chapter 70.122 RCW)
32
33
. . . . . . I have appointed more than one agent. I understand that the most recently appointed agent controls except as stated
below:
34
35
PART IX.
NOTIFICATION OF OTHERS AND CARE OF PERSONAL AFFAIRS
p. 200 HB 2127
1 (Fill out this part only if you wish to provide nontreatment instructions.)
2
3
I understand the preferences and instructions in this part are NOT the responsibility of my treatment provider and that no
treatment provider is required to act on them.
4 A. Who Should Be Notified
5 I desire my agent to notify the following individuals as soon as possible if I am admitted to a mental health facility:
6 Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Day telephone: . . . . . . . . . . . . . . . . . . . . . . . . . Evening telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9 Day telephone: . . . . . . . . . . . . . . . . . . . . . . . . . Evening telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11 Day telephone: . . . . . . . . . . . . . . . . . . . . . . . . . Evening telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12 B. Preferences or Instructions About Personal Affairs
13
14
I have the following preferences or instructions about my personal affairs (e.g., care of dependents, pets, household) if I am
admitted to a mental health treatment facility:
15 C. Additional Preferences and Instructions:
16
17
PART X.
SIGNATURE
18
19
20
21
By signing here, I indicate that I understand the purpose and effect of this document and that I am giving my informed
consent to the treatments and/or admission to which I have consented or authorized my agent to consent in this directive. I
intend that my consent in this directive be construed as being consistent with the elements of informed consent under
chapter 7.70 RCW.
22
23
In witness of this, I have signed on this . . . . . . day of . . . . . ., 20. . . .
Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24
25
26
27
28
29
30
31
32
33
STATE OF WASHINGTON )
) ss.
COUNTY OF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )
I certify that I know or have satisfactory evidence that (client name) is
the person who appeared before me, and said person acknowledged that
he or she signed this Durable Power of Attorney and acknowledged it to
be his or her free and voluntary act for the uses and purposes mentioned
in this instrument.
SUBSCRIBED and SWORN to before me this . . . . . . day of . . . . . .,
20. . . .

p. 201 HB 2127
1
2
3
4
5
6
7
8
9
10
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SIGNATURE OF NOTARY

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PRINT NAME OF NOTARY

NOTARY PUBLIC for the State of Washington at . . . . . . . . . . . . . . . . .
My commission expires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
OR have two witnesses:
Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11
12
13
14
This directive was signed and declared by the "Principal," to be his or her directive, in our presence who, at his or her
request, have signed our names below as witnesses. We declare that, at the time of the creation of this instrument, the
Principal is personally known to us, and, according to our best knowledge and belief, has capacity at this time and does not
appear to be acting under duress, undue influence, or fraud. We further declare that none of us is:
15 (A) A person designated to make medical decisions on the principal's behalf;
16
17
(B) A health care provider or professional person directly involved with the provision of care to the principal at the time the
directive is executed;
18
19
(C) An owner, operator, employee, or relative of an owner or operator of a health care facility or long-term care facility in
which the principal is a patient or resident;
20
21
(D) A person who is related by blood, marriage, or adoption to the person, or with whom the principal has a dating
relationship as defined in RCW 7.105.010;
22 (E) An incapacitated person;
23 (F) A person who would benefit financially if the principal undergoes mental health treatment; or
24 (G) A minor.
25 Witness 1 Signature: . . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26 Printed Name: . . . . . . . . . . . . . . . . . . . . . . . . . . Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27 Telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28 Witness 2 Signature: . . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29 Printed Name: . . . . . . . . . . . . . . . . . . . . . . . . . . Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30 Telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
32
PART XI.
RECORD OF DIRECTIVE
33 I have given a copy of this directive to the following persons:
34 Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35 Day telephone: . . . . . . . . . . . . . . . . . . . . . . . . . Evening telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
p. 202 HB 2127
1 Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Day telephone: . . . . . . . . . . . . . . . . . . . . . . . . . Evening telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
4
5

DO NOT FILL OUT PART XII UNLESS YOU INTEND TO REVOKE
THIS DIRECTIVE IN PART OR IN WHOLE

6
7
PART XII.
REVOCATION OF THIS DIRECTIVE
8
9
(Initial any that apply):
. . . . . . I am revoking the following part(s) of this directive (specify):
10 Date: . . . . . . . . .
11 . . . . . . I am revoking all of this directive.
12
13
14
By signing here, I indicate that I understand the purpose and effect of my revocation and that no person is bound by any
revoked provision(s). I intend this revocation to be interpreted as if I had never completed the revoked provision(s).

15
16
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Signature)

17 Printed Name: . . . . . . . . . . . . . . . . . . . . . . . . . .
18
19
DO NOT SIGN THIS PART UNLESS YOU INTEND TO REVOKE THIS
DIRECTIVE IN PART OR IN WHOLE
Sec. 120. RCW 71.34.020 and 2025 c 226 s 6 are each amended to 20
read as follows: 21
Unless the context clearly requires otherwise, the definitions in 22
this section apply throughout this chapter. 23
(1) "23-hour crisis relief center" has the same meaning as 24
provided in RCW 71.24.025. 25
(2) "Admission" or "admit" means a decision by a physician, 26
physician ((assistant)) associate, or psychiatric advanced registered 27
nurse practitioner that a minor should be examined or treated as a 28
patient in a hospital. 29
(3) "Adolescent" means a minor thirteen years of age or older.30
(4) "Alcoholism" means a disease, characterized by a dependency 31
on alcoholic beverages, loss of control over the amount and 32
circumstances of use, symptoms of tolerance, physiological or 33
psychological withdrawal, or both, if use is reduced or discontinued, 34
and impairment of health or disruption of social or economic 35
functioning. 36
p. 203 HB 2127
(5) "Antipsychotic medications" means that class of drugs 1
primarily used to treat serious manifestations of mental illness 2
associated with thought disorders, which includes, but is not limited 3
to, atypical antipsychotic medications. 4
(6) "Approved substance use disorder treatment program" means a 5
program for minors with substance use disorders provided by a 6
treatment program licensed or certified by the department of health 7
as meeting standards adopted under chapter 71.24 RCW.8
(7) "Attending staff" means any person on the staff of a public 9
or private agency having responsibility for the care and treatment of 10
a minor patient. 11
(8) "Authority" means the Washington state health care authority.12
(9) "Behavioral health administrative services organization" has 13
the same meaning as provided in RCW 71.24.025. 14
(10) "Behavioral health disorder" means either a mental disorder 15
as defined in this section, a substance use disorder as defined in 16
this section, or a co-occurring mental disorder and substance use 17
disorder. 18
(11) "Child psychiatrist" means a person having a license as a 19
physician and surgeon in this state, who has had graduate training in 20
child psychiatry in a program approved by the American Medical 21
Association or the American Osteopathic Association, and who is board 22
eligible or board certified in child psychiatry. 23
(12) "Children's mental health specialist" means:24
(a) A mental health professional who has completed a minimum of 25
one hundred actual hours, not quarter or semester hours, of 26
specialized training devoted to the study of child development and 27
the treatment of children; and 28
(b) A mental health professional who has the equivalent of one 29
year of full-time experience in the treatment of children under the 30
supervision of a children's mental health specialist.31
(13) "Commitment" means a determination by a judge or court 32
commissioner, made after a commitment hearing, that the minor is in 33
need of inpatient diagnosis, evaluation, or treatment or that the 34
minor is in need of less restrictive alternative treatment.35
(14) "Conditional release" means a revocable modification of a 36
commitment, which may be revoked upon violation of any of its terms.37
(15) "Co-occurring disorder specialist" means an individual 38
possessing an enhancement granted by the department of health under 39
chapter 18.205 RCW that certifies the individual to provide substance 40
p. 204 HB 2127
use disorder counseling subject to the practice limitations under RCW 1
18.205.105. 2
(16) "Crisis stabilization unit" means a short-term facility or a 3
portion of a facility licensed or certified by the department of 4
health under RCW 71.24.035, such as a residential treatment facility 5
or a hospital, which has been designed to assess, diagnose, and treat 6
individuals experiencing an acute crisis without the use of long-term 7
hospitalization, or to determine the need for involuntary commitment 8
of an individual. 9
(17) "Custody" means involuntary detention under the provisions 10
of this chapter or chapter 10.77 RCW, uninterrupted by any period of 11
unconditional release from commitment from a facility providing 12
involuntary care and treatment. 13
(18) "Department" means the department of social and health 14
services. 15
(19) "Designated crisis responder" has the same meaning as 16
provided in RCW 71.05.020. 17
(20) "Detention" or "detain" means the lawful confinement of a 18
person, under the provisions of this chapter. 19
(21) "Developmental disabilities professional" means a person who 20
has specialized training and three years of experience in directly 21
treating or working with persons with developmental disabilities and 22
is a psychiatrist, physician ((assistant)) associate working with a 23
supervising psychiatrist, psychologist, psychiatric advanced 24
registered nurse practitioner, or social worker, and such other 25
developmental disabilities professionals as may be defined by rules 26
adopted by the secretary of the department. 27
(22) "Developmental disability" has the same meaning as defined 28
in RCW 71A.10.020. 29
(23) "Director" means the director of the authority.30
(24) "Discharge" means the termination of hospital medical 31
authority. The commitment may remain in place, be terminated, or be 32
amended by court order. 33
(25) "Evaluation and treatment facility" means a public or 34
private facility or unit that is licensed or certified by the 35
department of health to provide emergency, inpatient, residential, or 36
outpatient mental health evaluation and treatment services for 37
minors. A physically separate and separately operated portion of a 38
state hospital may be designated as an evaluation and treatment 39
facility for minors. A facility which is part of or operated by the 40
p. 205 HB 2127
state or federal agency does not require licensure or certification. 1
No correctional institution or facility, juvenile court detention 2
facility, or jail may be an evaluation and treatment facility within 3
the meaning of this chapter. 4
(26) "Evaluation and treatment program" means the total system of 5
services and facilities coordinated and approved by a county or 6
combination of counties for the evaluation and treatment of minors 7
under this chapter. 8
(27) "Gravely disabled minor" means a minor who, as a result of a 9
behavioral health disorder, (a) is in danger of serious physical harm 10
resulting from a failure to provide for his or her essential human 11
needs of health or safety, or (b) manifests severe deterioration in 12
routine functioning evidenced by repeated and escalating loss of 13
cognitive or volitional control over his or her actions and is not 14
receiving such care as is essential for his or her health or safety.15
(28) "Habilitative services" means those services provided by 16
program personnel to assist minors in acquiring and maintaining life 17
skills and in raising their levels of physical, behavioral, social, 18
and vocational functioning. Habilitative services include education, 19
training for employment, and therapy. 20
(29) "Hearing" means any proceeding conducted in open court that 21
conforms to the requirements of RCW 71.34.910. 22
(30) "History of one or more violent acts" refers to the period 23
of time five years prior to the filing of a petition under this 24
chapter, excluding any time spent, but not any violent acts 25
committed, in a mental health facility, a long-term substance use 26
disorder treatment facility, or in confinement as a result of a 27
criminal conviction. 28
(31) "Individualized service plan" means a plan prepared by a 29
developmental disabilities professional with other professionals as a 30
team, for a person with developmental disabilities, which states:31
(a) The nature of the person's specific problems, prior charged 32
criminal behavior, and habilitation needs; 33
(b) The conditions and strategies necessary to achieve the 34
purposes of habilitation; 35
(c) The intermediate and long-range goals of the habilitation 36
program, with a projected timetable for the attainment;37
(d) The rationale for using this plan of habilitation to achieve 38
those intermediate and long-range goals; 39
(e) The staff responsible for carrying out the plan;40
p. 206 HB 2127
(f) Where relevant in light of past criminal behavior and due 1
consideration for public safety, the criteria for proposed movement 2
to less-restrictive settings, criteria for proposed eventual 3
discharge or release, and a projected possible date for discharge or 4
release; and 5
(g) The type of residence immediately anticipated for the person 6
and possible future types of residences. 7
(32)(a) "Inpatient treatment" means twenty-four-hour-per-day 8
mental health care provided within a general hospital, psychiatric 9
hospital, residential treatment facility licensed or certified by the 10
department of health as an evaluation and treatment facility for 11
minors, secure withdrawal management and stabilization facility for 12
minors, or approved substance use disorder treatment program for 13
minors. 14
(b) For purposes of family-initiated treatment under RCW 15
71.34.600 through 71.34.670, "inpatient treatment" has the meaning 16
included in (a) of this subsection and any other residential 17
treatment facility licensed under chapter 71.12 RCW.18
(33) "Intoxicated minor" means a minor whose mental or physical 19
functioning is substantially impaired as a result of the use of 20
alcohol or other psychoactive chemicals. 21
(34) "Judicial commitment" means a commitment by a court pursuant 22
to the provisions of this chapter. 23
(35) "Kinship caregiver" has the same meaning as in RCW 24
74.13.031. 25
(36) "Legal counsel" means attorneys and staff employed by county 26
prosecutor offices or the state attorney general acting in their 27
capacity as legal representatives of public behavioral health service 28
providers under RCW 71.05.130. 29
(37) "Less restrictive alternative" or "less restrictive setting" 30
means outpatient treatment provided to a minor as a program of 31
individualized treatment in a less restrictive setting than inpatient 32
treatment that includes the services described in RCW 71.34.755, 33
including residential treatment. 34
(38) "Licensed physician" means a person licensed to practice 35
medicine or osteopathic medicine and surgery in the state of 36
Washington. 37
(39) "Likelihood of serious harm" means: 38
(a) A substantial risk that: (i) Physical harm will be inflicted 39
by a minor upon his or her own person, as evidenced by threats or 40
p. 207 HB 2127
attempts to commit suicide or inflict physical harm on oneself; (ii) 1
physical harm will be inflicted by a minor upon another individual, 2
as evidenced by behavior which has caused such harm or which places 3
another person or persons in reasonable fear of sustaining such harm; 4
or (iii) physical harm will be inflicted by a minor upon the property 5
of others, as evidenced by behavior which has caused substantial loss 6
or damage to the property of others; or 7
(b) The minor has threatened the physical safety of another and 8
has a history of one or more violent acts. 9
(40) "Managed care organization" has the same meaning as provided 10
in RCW 71.24.025. 11
(41) "Medical clearance" means a physician or other health care 12
provider, including an Indian health care provider, has determined 13
that a person is medically stable and ready for referral to the 14
designated crisis responder or facility. For a person presenting in 15
the community, no medical clearance is required prior to 16
investigation by a designated crisis responder. 17
(42) "Medical necessity" for inpatient care means a requested 18
service which is reasonably calculated to: (a) Diagnose, correct, 19
cure, or alleviate a mental disorder or substance use disorder; or 20
(b) prevent the progression of a mental disorder or substance use 21
disorder that endangers life or causes suffering and pain, or results 22
in illness or infirmity or threatens to cause or aggravate a 23
disability, or causes physical deformity or malfunction, and there is 24
no adequate less restrictive alternative available.25
(43) "Mental disorder" means any organic, mental, or emotional 26
impairment that has substantial adverse effects on an individual's 27
cognitive or volitional functions. The presence of alcohol abuse, 28
drug abuse, juvenile criminal history, antisocial behavior, or 29
intellectual disabilities alone is insufficient to justify a finding 30
of "mental disorder" within the meaning of this section.31
(44) "Mental health professional" has the same meaning as 32
provided in RCW 71.05.020. 33
(45) "Minor" means any person under the age of eighteen years.34
(46) "Outpatient treatment" means any of the nonresidential 35
services mandated under chapter 71.24 RCW and provided by licensed or 36
certified behavioral health agencies as identified by RCW 71.24.025.37
(47)(a) "Parent" has the same meaning as defined in RCW 38
26.26A.010, including either parent if custody is shared under a 39
p. 208 HB 2127
joint custody agreement, or a person or agency judicially appointed 1
as legal guardian or custodian of the child. 2
(b) For purposes of family-initiated treatment under RCW 3
71.34.600 through 71.34.670, "parent" also includes a person to whom 4
a parent defined in (a) of this subsection has given a signed 5
authorization to make health care decisions for the adolescent, a 6
stepparent who is involved in caring for the adolescent, a kinship 7
caregiver who is involved in caring for the adolescent, or another 8
relative who is responsible for the health care of the adolescent, 9
who may be required to provide a declaration under penalty of perjury 10
stating that he or she is a relative responsible for the health care 11
of the adolescent pursuant to chapter 5.50 RCW. If a dispute arises 12
between individuals authorized to act as a parent for the purpose of 13
RCW 71.34.600 through 71.34.670, the disagreement must be resolved 14
according to the priority established under RCW 7.70.065(2)(a).15
(48) "Peace officer" means a law enforcement official of a public 16
agency or governmental unit, and includes persons specifically given 17
peace officer powers by any state law, local ordinance, or judicial 18
order of appointment. 19
(49) "Physician ((assistant)) associate" means a person licensed 20
as a physician ((assistant)) associate under chapter 18.71A RCW.21
(50) "Private agency" means any person, partnership, corporation, 22
or association that is not a public agency, whether or not financed 23
in whole or in part by public funds, that constitutes an evaluation 24
and treatment facility or private institution, or hospital, or 25
approved substance use disorder treatment program, that is conducted 26
for, or includes a distinct unit, floor, or ward conducted for, the 27
care and treatment of persons with mental illness, substance use 28
disorders, or both mental illness and substance use disorders.29
(51) "Professional person in charge" or "professional person" 30
means a physician, other mental health professional, or other person 31
empowered by an evaluation and treatment facility, secure withdrawal 32
management and stabilization facility, or approved substance use 33
disorder treatment program with authority to make admission and 34
discharge decisions on behalf of that facility. 35
(52) "Psychiatric nurse" means a registered nurse who has 36
experience in the direct treatment of persons who have a mental 37
illness or who are emotionally disturbed, such experience gained 38
under the supervision of a mental health professional.39
p. 209 HB 2127
(53) "Psychiatrist" means a person having a license as a 1
physician in this state who has completed residency training in 2
psychiatry in a program approved by the American Medical Association 3
or the American Osteopathic Association, and is board eligible or 4
board certified in psychiatry. 5
(54) "Psychologist" means a person licensed as a psychologist 6
under chapter 18.83 RCW. 7
(55) "Public agency" means any evaluation and treatment facility 8
or institution, or hospital, or approved substance use disorder 9
treatment program that is conducted for, or includes a distinct unit, 10
floor, or ward conducted for, the care and treatment of persons with 11
mental illness, substance use disorders, or both mental illness and 12
substance use disorders if the agency is operated directly by 13
federal, state, county, or municipal government, or a combination of 14
such governments. 15
(56) "Release" means legal termination of the commitment under 16
the provisions of this chapter. 17
(57) "Resource management services" has the meaning given in 18
chapter 71.24 RCW. 19
(58) "Responsible other" means the minor, the minor's parent or 20
estate, or any other person legally responsible for support of the 21
minor. 22
(59) "Secretary" means the secretary of the department or 23
secretary's designee. 24
(60) "Secure withdrawal management and stabilization facility" 25
means a facility operated by either a public or private agency or by 26
the program of an agency which provides care to voluntary individuals 27
and individuals involuntarily detained and committed under this 28
chapter for whom there is a likelihood of serious harm or who are 29
gravely disabled due to the presence of a substance use disorder. 30
Secure withdrawal management and stabilization facilities must:31
(a) Provide the following services: 32
(i) Assessment and treatment, provided by certified substance use 33
disorder professionals or co-occurring disorder specialists;34
(ii) Clinical stabilization services; 35
(iii) Acute or subacute detoxification services for intoxicated 36
individuals; and 37
(iv) Discharge assistance provided by certified substance use 38
disorder professionals or co-occurring disorder specialists, 39
including facilitating transitions to appropriate voluntary or 40
p. 210 HB 2127
involuntary inpatient services or to less restrictive alternatives as 1
appropriate for the individual; 2
(b) Include security measures sufficient to protect the patients, 3
staff, and community; and 4
(c) Be licensed or certified as such by the department of health.5
(61) "Social worker" means a person with a master's or further 6
advanced degree from a social work educational program accredited and 7
approved as provided in RCW 18.320.010. 8
(62) "Start of initial detention" means the time of arrival of 9
the minor at the first evaluation and treatment facility, secure 10
withdrawal management and stabilization facility, or approved 11
substance use disorder treatment program offering inpatient treatment 12
if the minor is being involuntarily detained at the time. With regard 13
to voluntary patients, "start of initial detention" means the time at 14
which the minor gives notice of intent to leave under the provisions 15
of this chapter. 16
(63) "State hospital" means a hospital designated under RCW 17
72.23.020. 18
(64) "Store and forward technology" means use of an asynchronous 19
transmission of a person's medical information from a mental health 20
service provider to the designated crisis responder which results in 21
medical diagnosis, consultation, or treatment. 22
(65) "Substance use disorder" means a cluster of cognitive, 23
behavioral, and physiological symptoms indicating that an individual 24
continues using the substance despite significant substance-related 25
problems. The diagnosis of a substance use disorder is based on a 26
pathological pattern of behaviors related to the use of the 27
substances. 28
(66) "Substance use disorder professional" means a person 29
certified as a substance use disorder professional by the department 30
of health under chapter 18.205 RCW. 31
(67) "Therapeutic court personnel" means the staff of a mental 32
health court or other therapeutic court which has jurisdiction over 33
defendants who are dually diagnosed with mental disorders, including 34
court personnel, probation officers, a court monitor, prosecuting 35
attorney, or defense counsel acting within the scope of therapeutic 36
court duties. 37
(68) "Treatment records" include registration and all other 38
records concerning persons who are receiving or who at any time have 39
received services for mental illness, which are maintained by the 40
p. 211 HB 2127
department, the department of health, the authority, behavioral 1
health organizations and their staffs, and by treatment facilities. 2
Treatment records include mental health information contained in a 3
medical bill including but not limited to mental health drugs, a 4
mental health diagnosis, provider name, and dates of service stemming 5
from a medical service. Treatment records do not include notes or 6
records maintained for personal use by a person providing treatment 7
services for the department, the department of health, the authority, 8
behavioral health organizations, or a treatment facility if the notes 9
or records are not available to others. 10
(69) "Tribe" has the same meaning as in RCW 71.24.025.11
(70) "Video" means the delivery of behavioral health services 12
through the use of interactive audio and video technology, permitting 13
real-time communication between a person and a designated crisis 14
responder, for the purpose of evaluation. "Video" does not include 15
the use of audio-only telephone, facsimile, email, or store and 16
forward technology. 17
(71) "Violent act" means behavior that resulted in homicide, 18
attempted suicide, injury, or substantial loss or damage to property.19
Sec. 121. RCW 71.34.020 and 2025 c 226 s 7 are each amended to 20
read as follows: 21
Unless the context clearly requires otherwise, the definitions in 22
this section apply throughout this chapter. 23
(1) "23-hour crisis relief center" has the same meaning as 24
provided in RCW 71.24.025. 25
(2) "Admission" or "admit" means a decision by a physician, 26
physician ((assistant)) associate, or psychiatric advanced registered 27
nurse practitioner that a minor should be examined or treated as a 28
patient in a hospital. 29
(3) "Adolescent" means a minor thirteen years of age or older.30
(4) "Alcoholism" means a disease, characterized by a dependency 31
on alcoholic beverages, loss of control over the amount and 32
circumstances of use, symptoms of tolerance, physiological or 33
psychological withdrawal, or both, if use is reduced or discontinued, 34
and impairment of health or disruption of social or economic 35
functioning. 36
(5) "Antipsychotic medications" means that class of drugs 37
primarily used to treat serious manifestations of mental illness 38
p. 212 HB 2127
associated with thought disorders, which includes, but is not limited 1
to, atypical antipsychotic medications. 2
(6) "Approved substance use disorder treatment program" means a 3
program for minors with substance use disorders provided by a 4
treatment program licensed or certified by the department of health 5
as meeting standards adopted under chapter 71.24 RCW.6
(7) "Attending staff" means any person on the staff of a public 7
or private agency having responsibility for the care and treatment of 8
a minor patient. 9
(8) "Authority" means the Washington state health care authority.10
(9) "Behavioral health administrative services organization" has 11
the same meaning as provided in RCW 71.24.025. 12
(10) "Behavioral health disorder" means either a mental disorder 13
as defined in this section, a substance use disorder as defined in 14
this section, or a co-occurring mental disorder and substance use 15
disorder. 16
(11) "Child psychiatrist" means a person having a license as a 17
physician and surgeon in this state, who has had graduate training in 18
child psychiatry in a program approved by the American Medical 19
Association or the American Osteopathic Association, and who is board 20
eligible or board certified in child psychiatry. 21
(12) "Children's mental health specialist" means:22
(a) A mental health professional who has completed a minimum of 23
one hundred actual hours, not quarter or semester hours, of 24
specialized training devoted to the study of child development and 25
the treatment of children; and 26
(b) A mental health professional who has the equivalent of one 27
year of full-time experience in the treatment of children under the 28
supervision of a children's mental health specialist.29
(13) "Commitment" means a determination by a judge or court 30
commissioner, made after a commitment hearing, that the minor is in 31
need of inpatient diagnosis, evaluation, or treatment or that the 32
minor is in need of less restrictive alternative treatment.33
(14) "Conditional release" means a revocable modification of a 34
commitment, which may be revoked upon violation of any of its terms.35
(15) "Co-occurring disorder specialist" means an individual 36
possessing an enhancement granted by the department of health under 37
chapter 18.205 RCW that certifies the individual to provide substance 38
use disorder counseling subject to the practice limitations under RCW 39
18.205.105. 40
p. 213 HB 2127
(16) "Crisis stabilization unit" means a short-term facility or a 1
portion of a facility licensed or certified by the department of 2
health under RCW 71.24.035, such as a residential treatment facility 3
or a hospital, which has been designed to assess, diagnose, and treat 4
individuals experiencing an acute crisis without the use of long-term 5
hospitalization, or to determine the need for involuntary commitment 6
of an individual. 7
(17) "Custody" means involuntary detention under the provisions 8
of this chapter or chapter 10.77 RCW, uninterrupted by any period of 9
unconditional release from commitment from a facility providing 10
involuntary care and treatment. 11
(18) "Department" means the department of social and health 12
services. 13
(19) "Designated crisis responder" has the same meaning as 14
provided in RCW 71.05.020. 15
(20) "Detention" or "detain" means the lawful confinement of a 16
person, under the provisions of this chapter. 17
(21) "Developmental disabilities professional" means a person who 18
has specialized training and three years of experience in directly 19
treating or working with persons with developmental disabilities and 20
is a psychiatrist, physician ((assistant)) associate working with a 21
supervising psychiatrist, psychologist, psychiatric advanced 22
registered nurse practitioner, or social worker, and such other 23
developmental disabilities professionals as may be defined by rules 24
adopted by the secretary of the department. 25
(22) "Developmental disability" has the same meaning as defined 26
in RCW 71A.10.020. 27
(23) "Director" means the director of the authority.28
(24) "Discharge" means the termination of hospital medical 29
authority. The commitment may remain in place, be terminated, or be 30
amended by court order. 31
(25) "Evaluation and treatment facility" means a public or 32
private facility or unit that is licensed or certified by the 33
department of health to provide emergency, inpatient, residential, or 34
outpatient mental health evaluation and treatment services for 35
minors. A physically separate and separately operated portion of a 36
state hospital may be designated as an evaluation and treatment 37
facility for minors. A facility which is part of or operated by the 38
state or federal agency does not require licensure or certification. 39
No correctional institution or facility, juvenile court detention 40
p. 214 HB 2127
facility, or jail may be an evaluation and treatment facility within 1
the meaning of this chapter. 2
(26) "Evaluation and treatment program" means the total system of 3
services and facilities coordinated and approved by a county or 4
combination of counties for the evaluation and treatment of minors 5
under this chapter. 6
(27) "Gravely disabled minor" means a minor who, as a result of a 7
behavioral health disorder, (a) is in danger of serious physical harm 8
resulting from a failure to provide for his or her essential human 9
needs of health or safety, or (b) manifests severe deterioration from 10
safe behavior evidenced by repeated and escalating loss of cognitive 11
or volitional control over his or her actions and is not receiving 12
such care as is essential for his or her health or safety.13
(28) "Habilitative services" means those services provided by 14
program personnel to assist minors in acquiring and maintaining life 15
skills and in raising their levels of physical, behavioral, social, 16
and vocational functioning. Habilitative services include education, 17
training for employment, and therapy. 18
(29) "Hearing" means any proceeding conducted in open court that 19
conforms to the requirements of RCW 71.34.910. 20
(30) "History of one or more violent acts" refers to the period 21
of time five years prior to the filing of a petition under this 22
chapter, excluding any time spent, but not any violent acts 23
committed, in a mental health facility, a long-term substance use 24
disorder treatment facility, or in confinement as a result of a 25
criminal conviction. 26
(31) "Individualized service plan" means a plan prepared by a 27
developmental disabilities professional with other professionals as a 28
team, for a person with developmental disabilities, which states:29
(a) The nature of the person's specific problems, prior charged 30
criminal behavior, and habilitation needs; 31
(b) The conditions and strategies necessary to achieve the 32
purposes of habilitation; 33
(c) The intermediate and long-range goals of the habilitation 34
program, with a projected timetable for the attainment;35
(d) The rationale for using this plan of habilitation to achieve 36
those intermediate and long-range goals; 37
(e) The staff responsible for carrying out the plan;38
(f) Where relevant in light of past criminal behavior and due 39
consideration for public safety, the criteria for proposed movement 40
p. 215 HB 2127
to less-restrictive settings, criteria for proposed eventual 1
discharge or release, and a projected possible date for discharge or 2
release; and 3
(g) The type of residence immediately anticipated for the person 4
and possible future types of residences. 5
(32)(a) "Inpatient treatment" means twenty-four-hour-per-day 6
mental health care provided within a general hospital, psychiatric 7
hospital, residential treatment facility licensed or certified by the 8
department of health as an evaluation and treatment facility for 9
minors, secure withdrawal management and stabilization facility for 10
minors, or approved substance use disorder treatment program for 11
minors. 12
(b) For purposes of family-initiated treatment under RCW 13
71.34.600 through 71.34.670, "inpatient treatment" has the meaning 14
included in (a) of this subsection and any other residential 15
treatment facility licensed under chapter 71.12 RCW.16
(33) "Intoxicated minor" means a minor whose mental or physical 17
functioning is substantially impaired as a result of the use of 18
alcohol or other psychoactive chemicals. 19
(34) "Judicial commitment" means a commitment by a court pursuant 20
to the provisions of this chapter. 21
(35) "Kinship caregiver" has the same meaning as in RCW 22
74.13.031. 23
(36) "Legal counsel" means attorneys and staff employed by county 24
prosecutor offices or the state attorney general acting in their 25
capacity as legal representatives of public behavioral health service 26
providers under RCW 71.05.130. 27
(37) "Less restrictive alternative" or "less restrictive setting" 28
means outpatient treatment provided to a minor as a program of 29
individualized treatment in a less restrictive setting than inpatient 30
treatment that includes the services described in RCW 71.34.755, 31
including residential treatment. 32
(38) "Licensed physician" means a person licensed to practice 33
medicine or osteopathic medicine and surgery in the state of 34
Washington. 35
(39) "Likelihood of serious harm" means: 36
(a) A substantial risk that: (i) Physical harm will be inflicted 37
by a minor upon his or her own person, as evidenced by threats or 38
attempts to commit suicide or inflict physical harm on oneself; (ii) 39
physical harm will be inflicted by a minor upon another individual, 40
p. 216 HB 2127
as evidenced by behavior which has caused harm, substantial pain, or 1
which places another person or persons in reasonable fear of harm to 2
themselves or others; or (iii) physical harm will be inflicted by a 3
minor upon the property of others, as evidenced by behavior which has 4
caused substantial loss or damage to the property of others; or5
(b) The minor has threatened the physical safety of another and 6
has a history of one or more violent acts. 7
(40) "Managed care organization" has the same meaning as provided 8
in RCW 71.24.025. 9
(41) "Medical clearance" means a physician or other health care 10
provider, including an Indian health care provider, has determined 11
that a person is medically stable and ready for referral to the 12
designated crisis responder or facility. For a person presenting in 13
the community, no medical clearance is required prior to 14
investigation by a designated crisis responder. 15
(42) "Medical necessity" for inpatient care means a requested 16
service which is reasonably calculated to: (a) Diagnose, correct, 17
cure, or alleviate a mental disorder or substance use disorder; or 18
(b) prevent the progression of a mental disorder or substance use 19
disorder that endangers life or causes suffering and pain, or results 20
in illness or infirmity or threatens to cause or aggravate a 21
disability, or causes physical deformity or malfunction, and there is 22
no adequate less restrictive alternative available.23
(43) "Mental disorder" means any organic, mental, or emotional 24
impairment that has substantial adverse effects on an individual's 25
cognitive or volitional functions. The presence of alcohol abuse, 26
drug abuse, juvenile criminal history, antisocial behavior, or 27
intellectual disabilities alone is insufficient to justify a finding 28
of "mental disorder" within the meaning of this section.29
(44) "Mental health professional" has the same meaning as 30
provided in RCW 71.05.020. 31
(45) "Minor" means any person under the age of eighteen years.32
(46) "Outpatient treatment" means any of the nonresidential 33
services mandated under chapter 71.24 RCW and provided by licensed or 34
certified behavioral health agencies as identified by RCW 71.24.025.35
(47)(a) "Parent" has the same meaning as defined in RCW 36
26.26A.010, including either parent if custody is shared under a 37
joint custody agreement, or a person or agency judicially appointed 38
as legal guardian or custodian of the child. 39
p. 217 HB 2127
(b) For purposes of family-initiated treatment under RCW 1
71.34.600 through 71.34.670, "parent" also includes a person to whom 2
a parent defined in (a) of this subsection has given a signed 3
authorization to make health care decisions for the adolescent, a 4
stepparent who is involved in caring for the adolescent, a kinship 5
caregiver who is involved in caring for the adolescent, or another 6
relative who is responsible for the health care of the adolescent, 7
who may be required to provide a declaration under penalty of perjury 8
stating that he or she is a relative responsible for the health care 9
of the adolescent pursuant to chapter 5.50 RCW. If a dispute arises 10
between individuals authorized to act as a parent for the purpose of 11
RCW 71.34.600 through 71.34.670, the disagreement must be resolved 12
according to the priority established under RCW 7.70.065(2)(a).13
(48) "Peace officer" means a law enforcement official of a public 14
agency or governmental unit, and includes persons specifically given 15
peace officer powers by any state law, local ordinance, or judicial 16
order of appointment. 17
(49) "Physician ((assistant)) associate" means a person licensed 18
as a physician ((assistant)) associate under chapter 18.71A RCW.19
(50) "Private agency" means any person, partnership, corporation, 20
or association that is not a public agency, whether or not financed 21
in whole or in part by public funds, that constitutes an evaluation 22
and treatment facility or private institution, or hospital, or 23
approved substance use disorder treatment program, that is conducted 24
for, or includes a distinct unit, floor, or ward conducted for, the 25
care and treatment of persons with mental illness, substance use 26
disorders, or both mental illness and substance use disorders.27
(51) "Professional person in charge" or "professional person" 28
means a physician, other mental health professional, or other person 29
empowered by an evaluation and treatment facility, secure withdrawal 30
management and stabilization facility, or approved substance use 31
disorder treatment program with authority to make admission and 32
discharge decisions on behalf of that facility. 33
(52) "Psychiatric nurse" means a registered nurse who has 34
experience in the direct treatment of persons who have a mental 35
illness or who are emotionally disturbed, such experience gained 36
under the supervision of a mental health professional.37
(53) "Psychiatrist" means a person having a license as a 38
physician in this state who has completed residency training in 39
psychiatry in a program approved by the American Medical Association 40
p. 218 HB 2127
or the American Osteopathic Association, and is board eligible or 1
board certified in psychiatry. 2
(54) "Psychologist" means a person licensed as a psychologist 3
under chapter 18.83 RCW. 4
(55) "Public agency" means any evaluation and treatment facility 5
or institution, or hospital, or approved substance use disorder 6
treatment program that is conducted for, or includes a distinct unit, 7
floor, or ward conducted for, the care and treatment of persons with 8
mental illness, substance use disorders, or both mental illness and 9
substance use disorders if the agency is operated directly by 10
federal, state, county, or municipal government, or a combination of 11
such governments. 12
(56) "Release" means legal termination of the commitment under 13
the provisions of this chapter. 14
(57) "Resource management services" has the meaning given in 15
chapter 71.24 RCW. 16
(58) "Responsible other" means the minor, the minor's parent or 17
estate, or any other person legally responsible for support of the 18
minor. 19
(59) "Secretary" means the secretary of the department or 20
secretary's designee. 21
(60) "Secure withdrawal management and stabilization facility" 22
means a facility operated by either a public or private agency or by 23
the program of an agency which provides care to voluntary individuals 24
and individuals involuntarily detained and committed under this 25
chapter for whom there is a likelihood of serious harm or who are 26
gravely disabled due to the presence of a substance use disorder. 27
Secure withdrawal management and stabilization facilities must:28
(a) Provide the following services: 29
(i) Assessment and treatment, provided by certified substance use 30
disorder professionals or co-occurring disorder specialists;31
(ii) Clinical stabilization services; 32
(iii) Acute or subacute detoxification services for intoxicated 33
individuals; and 34
(iv) Discharge assistance provided by certified substance use 35
disorder professionals or co-occurring disorder specialists, 36
including facilitating transitions to appropriate voluntary or 37
involuntary inpatient services or to less restrictive alternatives as 38
appropriate for the individual; 39
p. 219 HB 2127
(b) Include security measures sufficient to protect the patients, 1
staff, and community; and 2
(c) Be licensed or certified as such by the department of health.3
(61) "Severe deterioration from safe behavior" means that a 4
person will, if not treated, suffer or continue to suffer severe and 5
abnormal mental, emotional, or physical distress, and this distress 6
is associated with significant impairment of judgment, reason, or 7
behavior. 8
(62) "Social worker" means a person with a master's or further 9
advanced degree from a social work educational program accredited and 10
approved as provided in RCW 18.320.010. 11
(63) "Start of initial detention" means the time of arrival of 12
the minor at the first evaluation and treatment facility, secure 13
withdrawal management and stabilization facility, or approved 14
substance use disorder treatment program offering inpatient treatment 15
if the minor is being involuntarily detained at the time. With regard 16
to voluntary patients, "start of initial detention" means the time at 17
which the minor gives notice of intent to leave under the provisions 18
of this chapter. 19
(64) "State hospital" means a hospital designated under RCW 20
72.23.020. 21
(65) "Store and forward technology" means use of an asynchronous 22
transmission of a person's medical information from a mental health 23
service provider to the designated crisis responder which results in 24
medical diagnosis, consultation, or treatment. 25
(66) "Substance use disorder" means a cluster of cognitive, 26
behavioral, and physiological symptoms indicating that an individual 27
continues using the substance despite significant substance-related 28
problems. The diagnosis of a substance use disorder is based on a 29
pathological pattern of behaviors related to the use of the 30
substances. 31
(67) "Substance use disorder professional" means a person 32
certified as a substance use disorder professional by the department 33
of health under chapter 18.205 RCW. 34
(68) "Therapeutic court personnel" means the staff of a mental 35
health court or other therapeutic court which has jurisdiction over 36
defendants who are dually diagnosed with mental disorders, including 37
court personnel, probation officers, a court monitor, prosecuting 38
attorney, or defense counsel acting within the scope of therapeutic 39
court duties. 40
p. 220 HB 2127
(69) "Treatment records" include registration and all other 1
records concerning persons who are receiving or who at any time have 2
received services for mental illness, which are maintained by the 3
department, the department of health, the authority, behavioral 4
health organizations and their staffs, and by treatment facilities. 5
Treatment records include mental health information contained in a 6
medical bill including but not limited to mental health drugs, a 7
mental health diagnosis, provider name, and dates of service stemming 8
from a medical service. Treatment records do not include notes or 9
records maintained for personal use by a person providing treatment 10
services for the department, the department of health, the authority, 11
behavioral health organizations, or a treatment facility if the notes 12
or records are not available to others. 13
(70) "Tribe" has the same meaning as in RCW 71.24.025.14
(71) "Video" means the delivery of behavioral health services 15
through the use of interactive audio and video technology, permitting 16
real-time communication between a person and a designated crisis 17
responder, for the purpose of evaluation. "Video" does not include 18
the use of audio-only telephone, facsimile, email, or store and 19
forward technology. 20
(72) "Violent act" means behavior that resulted in homicide, 21
attempted suicide, injury, or substantial loss or damage to property.22
Sec. 122. RCW 71.34.355 and 2020 c 302 s 68 are each amended to 23
read as follows: 24
(1) Absent a risk to self or others, minors treated under this 25
chapter have the following rights, which shall be prominently posted 26
in the evaluation and treatment facility: 27
(a) To wear their own clothes and to keep and use personal 28
possessions; 29
(b) To keep and be allowed to spend a reasonable sum of their own 30
money for canteen expenses and small purchases; 31
(c) To have individual storage space for private use;32
(d) To have visitors at reasonable times; 33
(e) To have reasonable access to a telephone, both to make and 34
receive confidential calls; 35
(f) To have ready access to letter-writing materials, including 36
stamps, and to send and receive uncensored correspondence through the 37
mails; 38
p. 221 HB 2127
(g) To discuss treatment plans and decisions with mental health 1
professionals; 2
(h) To have the right to adequate care and individualized 3
treatment; 4
(i) To not be denied access to treatment by spiritual means 5
through prayer in accordance with the tenets and practices of a 6
church or religious denomination in addition to the treatment 7
otherwise proposed; 8
(j) Not to consent to the administration of antipsychotic 9
medications beyond the hearing conducted pursuant to RCW 71.34.750 or 10
the performance of electroconvulsive treatment or surgery, except 11
emergency lifesaving surgery, upon him or her, unless ordered by a 12
court under procedures described in RCW 71.05.217(1)(j). The minor's 13
parent may exercise this right on the minor's behalf, and must be 14
informed of any impending treatment; 15
(k) Not to have psychosurgery performed on him or her under any 16
circumstances. 17
(2)(a) Privileges between minors and physicians, physician 18
((assistants)) associates, psychologists, or psychiatric advanced 19
registered nurse practitioners are deemed waived in proceedings under 20
this chapter relating to the administration of antipsychotic 21
medications. As to other proceedings under this chapter, the 22
privileges are waived when a court of competent jurisdiction in its 23
discretion determines that such waiver is necessary to protect either 24
the detained minor or the public. 25
(b) The waiver of a privilege under this section is limited to 26
records or testimony relevant to evaluation of the detained minor for 27
purposes of a proceeding under this chapter. Upon motion by the 28
detained minor or on its own motion, the court shall examine a record 29
or testimony sought by a petitioner to determine whether it is within 30
the scope of the waiver. 31
(c) The record maker may not be required to testify in order to 32
introduce medical or psychological records of the detained minor so 33
long as the requirements of RCW 5.45.020 are met except that portions 34
of the record which contain opinions as to the detained minor's 35
mental state must be deleted from such records unless the person 36
making such conclusions is available for cross-examination.37
(3) No minor may be presumed incompetent as a consequence of 38
receiving an evaluation or voluntary or involuntary treatment for a 39
mental disorder or substance use disorder, under this chapter or any 40
p. 222 HB 2127
prior laws of this state dealing with mental illness or substance use 1
disorders. 2
Sec. 123. RCW 71.34.720 and 2025 c 58 s 5160 are each amended to 3
read as follows: 4
(1) Each minor approved by the facility for inpatient admission 5
shall be examined and evaluated by a children's mental health 6
specialist, for minors admitted as a result of a mental disorder, or 7
by a substance use disorder professional or co-occurring disorder 8
specialist, for minors admitted as a result of a substance use 9
disorder, as to the child's mental condition and by a physician, 10
physician ((assistant)) associate, or psychiatric advanced practice 11
registered nurse as to the child's physical condition within twenty-12
four hours of admission. Reasonable measures shall be taken to ensure 13
medical treatment is provided for any condition requiring immediate 14
medical attention. 15
(2) If, at any time during the involuntary treatment hold and 16
following the initial examination and evaluation, the children's 17
mental health specialist or substance use disorder specialist and the 18
physician, physician ((assistant)) associate, or psychiatric advanced 19
practice registered nurse determine that the initial needs of the 20
minor, if detained to an evaluation and treatment facility, would be 21
better served by placement in a secure withdrawal management and 22
stabilization facility or approved substance use disorder treatment 23
program or, if detained to a secure withdrawal management and 24
stabilization facility or approved substance use disorder treatment 25
program, would be better served in an evaluation and treatment 26
facility, then the minor shall be referred to the more appropriate 27
placement for the remainder of the current commitment period without 28
any need for further court review. 29
(3) The admitting facility shall take reasonable steps to notify 30
immediately the minor's parent of the admission. 31
(4) During the initial one hundred twenty hour treatment period, 32
the minor has a right to associate or receive communications from 33
parents or others unless the professional person in charge determines 34
that such communication would be seriously detrimental to the minor's 35
condition or treatment and so indicates in the minor's clinical 36
record, and notifies the minor's parents of this determination. A 37
minor must not be denied the opportunity to consult an attorney 38
unless there is an immediate risk of harm to the minor or others.39
p. 223 HB 2127
(5) If the evaluation and treatment facility, secure withdrawal 1
management and stabilization facility, or approved substance use 2
disorder treatment program admits the minor, it may detain the minor 3
for evaluation and treatment for a period not to exceed one hundred 4
twenty hours from the time of provisional acceptance. The computation 5
of such one hundred twenty hour period shall exclude Saturdays, 6
Sundays, and holidays. This initial treatment period shall not exceed 7
one hundred twenty hours except when an application for voluntary 8
inpatient treatment is received or a petition for fourteen-day 9
commitment is filed. 10
(6) Within twelve hours of the admission, the facility shall 11
advise the minor of his or her rights as set forth in this chapter.12
Sec. 124. RCW 71.34.730 and 2025 c 58 s 5161 are each amended to 13
read as follows: 14
(1) The professional person in charge of an evaluation and 15
treatment facility, secure withdrawal management and stabilization 16
facility, or approved substance use disorder treatment program where 17
a minor has been admitted involuntarily for the initial one hundred 18
twenty hour treatment period under this chapter may petition to have 19
a minor committed to an evaluation and treatment facility, a secure 20
withdrawal management and stabilization facility, or an approved 21
substance use disorder treatment program for fourteen-day diagnosis, 22
evaluation, and treatment. 23
If the professional person in charge of the facility does not 24
petition to have the minor committed, the parent who has custody of 25
the minor may seek review of that decision in court. The parent shall 26
file notice with the court and provide a copy of the treatment and 27
evaluation facility's report. 28
(2) A petition for commitment of a minor under this section shall 29
be filed with the superior court in the county where the minor is 30
being detained. 31
(a) A petition for a fourteen-day commitment shall be signed by:32
(i) One physician, physician ((assistant)) associate, or 33
psychiatric advanced practice registered nurse; and34
(ii) One physician, physician ((assistant)) associate, 35
psychiatric advanced practice registered nurse, or mental health 36
professional. 37
(b) If the petition is for substance use disorder treatment, the 38
petition may be signed by a substance use disorder professional 39
p. 224 HB 2127
instead of a mental health professional and by an advanced practice 1
registered nurse instead of a psychiatric advanced practice 2
registered nurse. The person signing the petition must have examined 3
the minor, and the petition must contain the following:4
(i) The name and address of the petitioner; 5
(ii) The name of the minor alleged to meet the criteria for 6
fourteen-day commitment; 7
(iii) The name, telephone number, and address if known of every 8
person believed by the petitioner to be legally responsible for the 9
minor; 10
(iv) A statement that the petitioner has examined the minor and 11
finds that the minor's condition meets required criteria for 12
fourteen-day commitment and the supporting facts therefor;13
(v) A statement that the minor has been advised of the need for 14
voluntary treatment but has been unwilling or unable to consent to 15
necessary treatment; 16
(vi) If the petition is for mental health treatment, a statement 17
that the minor has been advised of the loss of firearm rights if 18
involuntarily committed; 19
(vii) A statement recommending the appropriate facility or 20
facilities to provide the necessary treatment; and21
(viii) A statement concerning whether a less restrictive 22
alternative to inpatient treatment is in the best interests of the 23
minor. 24
(c) A copy of the petition shall be personally served on the 25
minor by the petitioner or petitioner's designee. A copy of the 26
petition shall be provided to the minor's attorney and the minor's 27
parent. 28
Sec. 125. RCW 71.34.750 and 2025 c 58 s 5162 are each amended to 29
read as follows: 30
(1) At any time during the minor's period of fourteen-day 31
commitment, the professional person in charge may petition the court 32
for an order requiring the minor to undergo an additional one hundred 33
eighty-day period of treatment. The evidence in support of the 34
petition shall be presented by the county prosecutor unless the 35
petition is filed by the professional person in charge of a state-36
operated facility in which case the evidence shall be presented by 37
the attorney general. 38
p. 225 HB 2127
(2) The petition for one hundred eighty-day commitment shall 1
contain the following: 2
(a) The name and address of the petitioner or petitioners;3
(b) The name of the minor alleged to meet the criteria for one 4
hundred eighty-day commitment; 5
(c) A statement that the petitioner is the professional person in 6
charge of the evaluation and treatment facility, secure withdrawal 7
management and stabilization facility, or approved substance use 8
disorder treatment program responsible for the treatment of the 9
minor; 10
(d) The date of the fourteen-day commitment order; and11
(e) A summary of the facts supporting the petition.12
(3) The petition shall be supported by accompanying affidavits 13
signed by: (a) Two examining physicians, one of whom shall be a child 14
psychiatrist, or two psychiatric advanced practice registered nurses, 15
one of whom shall be a child and adolescent or family psychiatric 16
advanced practice registered nurse. If the petition is for substance 17
use disorder treatment, the petition may be signed by a substance use 18
disorder professional instead of a mental health professional and by 19
an advanced practice registered nurse instead of a psychiatric 20
advanced practice registered nurse, or two physician ((assistants)) 21
associates, one of whom must be supervised by or collaborating with a 22
child psychiatrist; (b) one children's mental health specialist and 23
either an examining physician, physician ((assistant)) associate, or 24
a psychiatric advanced practice registered nurse; or (c) two among an 25
examining physician, physician ((assistant)) associate, and a 26
psychiatric advanced practice registered nurse, one of which needs to 27
be a child psychiatrist, a physician ((assistant)) associate 28
supervised by or collaborating with a child psychiatrist, or a child 29
and adolescent psychiatric nurse practitioner. The affidavits shall 30
describe in detail the behavior of the detained minor which supports 31
the petition and shall state whether a less restrictive alternative 32
to inpatient treatment is in the best interests of the minor.33
(4) The petition for one hundred eighty-day commitment shall be 34
filed with the clerk of the court at least three days before the 35
expiration of the fourteen-day commitment period. The petitioner or 36
the petitioner's designee shall within twenty-four hours of filing 37
serve a copy of the petition on the minor and notify the minor's 38
attorney and the minor's parent. A copy of the petition shall be 39
p. 226 HB 2127
provided to such persons at least twenty-four hours prior to the 1
hearing. 2
(5) At the time of filing, the court shall set a date within 3
seven days for the hearing on the petition. If the hearing is not 4
commenced within thirty days after the filing of the petition, 5
including extensions of time requested by the detained person or his 6
or her attorney or the court in the administration of justice under 7
RCW 71.34.735, the minor must be released. The minor or the parents 8
shall be afforded the same rights as in a fourteen-day commitment 9
hearing. Treatment of the minor shall continue pending the 10
proceeding. 11
(6) For one hundred eighty-day commitment, the court must find by 12
clear, cogent, and convincing evidence that the minor:13
(a) Is suffering from a mental disorder or substance use 14
disorder; 15
(b) Presents a likelihood of serious harm or is gravely disabled; 16
and 17
(c) Is in need of further treatment that only can be provided in 18
a one hundred eighty-day commitment. 19
(7) In determining whether an inpatient or less restrictive 20
alternative commitment is appropriate, great weight must be given to 21
evidence of a prior history or pattern of decompensation and 22
discontinuation of treatment resulting in: (a) Repeated 23
hospitalizations; or (b) repeated peace officer interventions 24
resulting in juvenile charges. Such evidence may be used to provide a 25
factual basis for concluding that the minor would not receive, if 26
released, such care as is essential for his or her health or safety.27
(8)(a) If the court finds that the criteria for commitment are 28
met and that less restrictive treatment in a community setting is not 29
appropriate or available, the court shall order the minor committed 30
to the custody of the director for further inpatient mental health 31
treatment, to an approved substance use disorder treatment program 32
for further substance use disorder treatment, or to a private 33
treatment and evaluation facility for inpatient mental health or 34
substance use disorder treatment if the minor's parents have assumed 35
responsibility for payment for the treatment. If the court finds that 36
a less restrictive alternative is in the best interest of the minor, 37
the court shall order less restrictive alternative treatment upon 38
such conditions as necessary. 39
p. 227 HB 2127
(b) If the court determines that the minor does not meet the 1
criteria for one hundred eighty-day commitment, the minor shall be 2
released. 3
(9) Successive one hundred eighty-day commitments are permissible 4
on the same grounds and under the same procedures as the original one 5
hundred eighty-day commitment. Such petitions shall be filed at least 6
three days prior to the expiration of the previous one hundred 7
eighty-day commitment order. 8
Sec. 126. RCW 71.34.755 and 2025 c 58 s 5163 are each amended to 9
read as follows: 10
(1) Less restrictive alternative treatment, at a minimum, must 11
include the following services: 12
(a) Assignment of a care coordinator; 13
(b) An intake evaluation with the provider of the less 14
restrictive alternative treatment; 15
(c) A psychiatric evaluation, a substance use disorder 16
evaluation, or both; 17
(d) A schedule of regular contacts with the provider of the less 18
restrictive alternative treatment services for the duration of the 19
order; 20
(e) A transition plan addressing access to continued services at 21
the expiration of the order; 22
(f) An individual crisis plan; 23
(g) Consultation about the formation of a mental health advance 24
directive under chapter 71.32 RCW; and 25
(h) Notification to the care coordinator assigned in (a) of this 26
subsection if reasonable efforts to engage the client fail to produce 27
substantial compliance with court-ordered treatment conditions.28
(2) Less restrictive alternative treatment may include the 29
following additional services: 30
(a) Medication management; 31
(b) Psychotherapy; 32
(c) Nursing; 33
(d) Substance use disorder counseling; 34
(e) Residential treatment; 35
(f) Partial hospitalization; 36
(g) Intensive outpatient treatment; 37
(h) Support for housing, benefits, education, and employment; and38
(i) Periodic court review. 39
p. 228 HB 2127
(3) If the minor was provided with involuntary medication during 1
the involuntary commitment period, the less restrictive alternative 2
treatment order may authorize the less restrictive alternative 3
treatment provider or its designee to administer involuntary 4
antipsychotic medication to the person if the provider has attempted 5
and failed to obtain the informed consent of the person and there is 6
a concurring medical opinion approving the medication by a 7
psychiatrist, physician ((assistant)) associate working with a 8
psychiatrist who is acting as a participating physician as defined in 9
RCW 18.71A.010, psychiatric advanced practice registered nurse, or 10
physician or physician ((assistant)) associate in consultation with 11
an independent mental health professional with prescribing authority.12
(4) Less restrictive alternative treatment must be administered 13
by a provider that is certified or licensed to provide or coordinate 14
the full scope of services required under the less restrictive 15
alternative order and that has agreed to assume this responsibility.16
(5) The care coordinator assigned to a minor ordered to less 17
restrictive alternative treatment must submit an individualized plan 18
for the minor's treatment services to the court that entered the 19
order. An initial plan must be submitted as soon as possible 20
following the intake evaluation and a revised plan must be submitted 21
upon any subsequent modification in which a type of service is 22
removed from or added to the treatment plan. 23
(6) A care coordinator may disclose information and records 24
related to mental health services pursuant to RCW 70.02.230(2)(k) for 25
purposes of implementing less restrictive alternative treatment.26
(7) For the purpose of this section, "care coordinator" means a 27
clinical practitioner who coordinates the activities of less 28
restrictive alternative treatment. The care coordinator coordinates 29
activities with the designated crisis responders that are necessary 30
for enforcement and continuation of less restrictive alternative 31
treatment orders and is responsible for coordinating service 32
activities with other agencies and establishing and maintaining a 33
therapeutic relationship with the individual on a continuing basis.34
Sec. 127. RCW 71.34.770 and 2025 c 58 s 5164 are each amended to 35
read as follows: 36
(1) The professional person in charge of the inpatient treatment 37
facility may authorize release for the minor under such conditions as 38
appropriate. Conditional release may be revoked pursuant to RCW 39
p. 229 HB 2127
71.34.780 if leave conditions are not met or the minor's functioning 1
substantially deteriorates. 2
(2) Minors may be discharged prior to expiration of the 3
commitment period if the treating physician, physician ((assistant)) 4
associate, psychiatric advanced practice registered nurse, or 5
professional person in charge concludes that the minor no longer 6
meets commitment criteria. 7
Sec. 128. RCW 71.34.815 and 2025 c 58 s 5165 are each amended to 8
read as follows: 9
(1) An adolescent is in need of assisted outpatient treatment if 10
the court finds by clear, cogent, and convincing evidence in response 11
to a petition filed under this section that: 12
(a) The adolescent has a behavioral health disorder;13
(b) Based on a clinical determination and in view of the 14
adolescent's treatment history and current behavior, at least one of 15
the following is true: 16
(i) The adolescent is unlikely to survive safely in the community 17
without supervision and the adolescent's condition is substantially 18
deteriorating; or 19
(ii) The adolescent is in need of assisted outpatient treatment 20
in order to prevent a relapse or deterioration that would be likely 21
to result in grave disability or a likelihood of serious harm to the 22
adolescent or to others; 23
(c) The adolescent has a history of lack of compliance with 24
treatment for his or her behavioral health disorder that has:25
(i) At least twice within the 36 months prior to the filing of 26
the petition been a significant factor in necessitating 27
hospitalization of the adolescent, or the adolescent's receipt of 28
services in a forensic or other mental health unit of a state, local, 29
or tribal correctional facility, provided that the 36-month period 30
shall be extended by the length of any hospitalization or 31
incarceration of the adolescent that occurred within the 36-month 32
period; 33
(ii) At least twice within the 36 months prior to the filing of 34
the petition been a significant factor in necessitating emergency 35
medical care or hospitalization for behavioral health-related medical 36
conditions including overdose, infected abscesses, sepsis, 37
endocarditis, or other maladies, or a significant factor in behavior 38
p. 230 HB 2127
which resulted in the adolescent's incarceration in a state, local, 1
or tribal correctional facility; or 2
(iii) Resulted in one or more violent acts, threats, or attempts 3
to cause serious physical harm to the adolescent or another within 4
the 48 months prior to the filing of the petition, provided that the 5
48-month period shall be extended by the length of any 6
hospitalization or incarceration of the person that occurred during 7
the 48-month period; 8
(d) Participation in an assisted outpatient treatment program 9
would be the least restrictive alternative necessary to ensure the 10
adolescent's recovery and stability; and 11
(e) The adolescent will benefit from assisted outpatient 12
treatment. 13
(2) The following individuals may directly file a petition for 14
less restrictive alternative treatment on the basis that an 15
adolescent is in need of assisted outpatient treatment:16
(a) The director of a hospital where the adolescent is 17
hospitalized or the director's designee; 18
(b) The director of a behavioral health service provider 19
providing behavioral health care or residential services to the 20
adolescent or the director's designee; 21
(c) The adolescent's treating mental health professional or 22
substance use disorder professional or one who has evaluated the 23
person; 24
(d) A designated crisis responder; 25
(e) A release planner from a juvenile detention or rehabilitation 26
facility; or 27
(f) An emergency room physician. 28
(3) A court order for less restrictive alternative treatment on 29
the basis that the adolescent is in need of assisted outpatient 30
treatment may be effective for up to 18 months. The petitioner must 31
personally interview the adolescent, unless the adolescent refuses an 32
interview, to determine whether the adolescent will voluntarily 33
receive appropriate treatment. 34
(4) The petitioner must allege specific facts based on personal 35
observation, evaluation, or investigation, and must consider the 36
reliability or credibility of any person providing information 37
material to the petition. 38
(5) The petition must include: 39
p. 231 HB 2127
(a) A statement of the circumstances under which the adolescent's 1
condition was made known and the basis for the opinion, from personal 2
observation or investigation, that the adolescent is in need of 3
assisted outpatient treatment. The petitioner must state which 4
specific facts come from personal observation and specify what other 5
sources of information the petitioner has relied upon to form this 6
belief; 7
(b) A declaration from a physician, physician ((assistant)) 8
associate, or advanced practice registered nurse, or the adolescent's 9
treating mental health professional or substance use disorder 10
professional, who has examined the adolescent no more than 10 days 11
prior to the submission of the petition and who is willing to testify 12
in support of the petition, or who alternatively has made appropriate 13
attempts to examine the adolescent within the same period but has not 14
been successful in obtaining the adolescent's cooperation, and who is 15
willing to testify to the reasons they believe that the adolescent 16
meets the criteria for assisted outpatient treatment. If the 17
declaration is provided by the adolescent's treating mental health 18
professional or substance use disorder professional, it must be 19
cosigned by a supervising physician, physician ((assistant)) 20
associate, or advanced practice registered nurse who certifies that 21
they have reviewed the declaration; 22
(c) The declarations of additional witnesses, if any, supporting 23
the petition for assisted outpatient treatment; 24
(d) The name of an agency, provider, or facility that agrees to 25
provide less restrictive alternative treatment if the petition is 26
granted by the court; and 27
(e) If the adolescent is detained in a state hospital, inpatient 28
treatment facility, or juvenile detention or rehabilitation facility 29
at the time the petition is filed, the anticipated release date of 30
the adolescent and any other details needed to facilitate successful 31
reentry and transition into the community. 32
(6)(a) Upon receipt of a petition meeting all requirements of 33
this section, the court shall fix a date for a hearing:34
(i) No sooner than three days or later than seven days after the 35
date of service or as stipulated by the parties or, upon a showing of 36
good cause, no later than 30 days after the date of service; or37
(ii) If the adolescent is hospitalized at the time of filing of 38
the petition, before discharge of the adolescent and in sufficient 39
p. 232 HB 2127
time to arrange for a continuous transition from inpatient treatment 1
to assisted outpatient treatment. 2
(b) A copy of the petition and notice of hearing shall be served, 3
in the same manner as a summons, on the petitioner, the adolescent, 4
the qualified professional whose affidavit accompanied the petition, 5
a current provider, if any, and a surrogate decision maker or agent 6
under chapter 71.32 RCW, if any. 7
(c) If the adolescent has a surrogate decision maker or agent 8
under chapter 71.32 RCW who wishes to provide testimony at the 9
hearing, the court shall afford the surrogate decision maker or agent 10
an opportunity to testify. 11
(d) The adolescent shall be represented by counsel at all stages 12
of the proceedings. 13
(e) If the adolescent fails to appear at the hearing after 14
notice, the court may conduct the hearing in the adolescent's 15
absence; provided that the adolescent's counsel is present.16
(f) If the adolescent has refused to be examined by the qualified 17
professional whose affidavit accompanied the petition, the court may 18
order a mental examination of the adolescent. The examination of the 19
adolescent may be performed by the qualified professional whose 20
affidavit accompanied the petition. If the examination is performed 21
by another qualified professional, the examining qualified 22
professional shall be authorized to consult with the qualified 23
professional whose affidavit accompanied the petition.24
(g) If the adolescent has refused to be examined by a qualified 25
professional and the court finds reasonable grounds to believe that 26
the allegations of the petition are true, the court may issue a 27
written order directing a peace officer who has completed crisis 28
intervention training to detain and transport the adolescent to a 29
provider for examination by a qualified professional. An adolescent 30
detained pursuant to this subsection shall be detained no longer than 31
necessary to complete the examination and in no event longer than 24 32
hours. All papers in the court file must be provided to the 33
adolescent's designated attorney. 34
(7) If the petition involves an adolescent whom the petitioner or 35
behavioral health administrative services organization knows, or has 36
reason to know, is an American Indian or Alaska Native who receives 37
medical or behavioral health services from a tribe within this state, 38
the petitioner or behavioral health administrative services 39
organization shall notify the tribe and Indian health care provider. 40
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Notification shall be made in person or by telephonic or electronic 1
communication to the tribal contact listed in the authority's tribal 2
crisis coordination plan as soon as possible, but before the hearing 3
and no later than 24 hours from the time the petition is served upon 4
the person and the person's guardian. The notice to the tribe or 5
Indian health care provider must include a copy of the petition, 6
together with any orders issued by the court and a notice of the 7
tribe's right to intervene. The court clerk shall provide copies of 8
any court orders necessary for the petitioner or the behavioral 9
health administrative services organization to provide notice to the 10
tribe or Indian health care provider under this section.11
(8) A petition for assisted outpatient treatment filed under this 12
section shall be adjudicated under RCW 71.34.740. 13
(9) After January 1, 2023, a petition for assisted outpatient 14
treatment must be filed on forms developed by the administrative 15
office of the courts. 16
Sec. 129. RCW 74.09.010 and 2025 c 58 s 5167 are each amended to 17
read as follows: 18
The definitions in this section apply throughout this chapter 19
unless the context clearly requires otherwise. 20
(1) "Authority" means the Washington state health care authority.21
(2) "Bidirectional integration" means integrating behavioral 22
health services into primary care settings and integrating primary 23
care services into behavioral health settings. 24
(3) "Children's health program" means the health care services 25
program provided to children under eighteen years of age and in 26
households with incomes at or below the federal poverty level as 27
annually defined by the federal department of health and human 28
services as adjusted for family size, and who are not otherwise 29
eligible for medical assistance or the limited casualty program for 30
the medically needy. 31
(4) "Chronic care management" means the health care management 32
within a health home of persons identified with, or at high risk for, 33
one or more chronic conditions. Effective chronic care management:34
(a) Actively assists patients to acquire self-care skills to 35
improve functioning and health outcomes, and slow the progression of 36
disease or disability; 37
(b) Employs evidence-based clinical practices;38
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(c) Coordinates care across health care settings and providers, 1
including tracking referrals; 2
(d) Provides ready access to behavioral health services that are, 3
to the extent possible, integrated with primary care; and4
(e) Uses appropriate community resources to support individual 5
patients and families in managing chronic conditions.6
(5) "Chronic condition" means a prolonged condition and includes, 7
but is not limited to: 8
(a) A mental health condition; 9
(b) A substance use disorder; 10
(c) Asthma; 11
(d) Diabetes; 12
(e) Heart disease; and 13
(f) Being overweight, as evidenced by a body mass index over 14
twenty-five. 15
(6) "County" means the board of county commissioners, county 16
council, county executive, or tribal jurisdiction, or its designee.17
(7) "Department" means the department of social and health 18
services. 19
(8) "Department of health" means the Washington state department 20
of health created pursuant to RCW 43.70.020. 21
(9) "Director" means the director of the Washington state health 22
care authority. 23
(10) "Full benefit dual eligible beneficiary" means an individual 24
who, for any month: Has coverage for the month under a medicare 25
prescription drug plan or medicare advantage plan with part D 26
coverage; and is determined eligible by the state for full medicaid 27
benefits for the month under any eligibility category in the state's 28
medicaid plan or a section 1115 demonstration waiver that provides 29
pharmacy benefits. 30
(11) "Health home" or "primary care health home" means 31
coordinated health care provided by a licensed primary care provider 32
coordinating all medical care services, and a multidisciplinary 33
health care team comprised of clinical and nonclinical staff. The 34
term "coordinating all medical care services" shall not be construed 35
to require prior authorization by a primary care provider in order 36
for a patient to receive treatment for covered services by an 37
optometrist licensed under chapter 18.53 RCW. Primary care health 38
home services shall include those services defined as health home 39
p. 235 HB 2127
services in 42 U.S.C. Sec. 1396w-4 and, in addition, may include, but 1
are not limited to: 2
(a) Comprehensive care management including, but not limited to, 3
chronic care treatment and management; 4
(b) Extended hours of service; 5
(c) Multiple ways for patients to communicate with the team, 6
including electronically and by phone; 7
(d) Education of patients on self-care, prevention, and health 8
promotion, including the use of patient decision aids;9
(e) Coordinating and assuring smooth transitions and follow-up 10
from inpatient to other settings; 11
(f) Individual and family support including authorized 12
representatives; 13
(g) The use of information technology to link services, track 14
tests, generate patient registries, and provide clinical data; and15
(h) Ongoing performance reporting and quality improvement.16
(12) "Limited casualty program" means the medical care program 17
provided to medically needy persons as defined under Title XIX of the 18
federal social security act, and to medically indigent persons who 19
are without income or resources sufficient to secure necessary 20
medical services. 21
(13) "Managed care organization" means any health care 22
organization, including health care providers, insurers, health care 23
service contractors, health maintenance organizations, health 24
insuring organizations, or any other entity or combination thereof, 25
that provides directly or by contract health care services covered 26
under this chapter and rendered by licensed providers, on a prepaid 27
capitated basis and that meets the requirements of section 28
1903(m)(1)(A) of Title XIX of the federal social security act or 29
federal demonstration waivers granted under section 1115 (a) of Title 30
XI of the federal social security act. 31
(14) "Medical assistance" means the federal aid medical care 32
program provided to categorically needy persons as defined under 33
Title XIX of the federal social security act. 34
(15) "Medical care services" means the limited scope of care 35
financed by state funds and provided to persons who are not eligible 36
for medicaid under RCW 74.09.510 and who are eligible for the aged, 37
blind, or disabled assistance program authorized in RCW 74.62.030 or 38
the essential needs and housing support program pursuant to RCW 39
74.04.805. 40
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(16) "Multidisciplinary health care team" means an 1
interdisciplinary team of health professionals which may include, but 2
is not limited to, medical specialists, nurses, pharmacists, 3
nutritionists, dieticians, social workers, behavioral and mental 4
health providers including substance use disorder prevention and 5
treatment providers, doctors of chiropractic, physical therapists, 6
licensed complementary and alternative medicine practitioners, home 7
care and other long-term care providers, and physicians' 8
((assistants)) associates. 9
(17) "Nursing home" means nursing home as defined in RCW 10
18.51.010. 11
(18) "Poverty" means the federal poverty level determined 12
annually by the United States department of health and human 13
services, or successor agency. 14
(19) "Primary care behavioral health" means a health care 15
integration model in which behavioral health care is colocated, 16
collaborative, and integrated within a primary care setting.17
(20) "Primary care provider" means a general practice physician, 18
family practitioner, internist, pediatrician, osteopathic physician, 19
naturopath, physician ((assistant)) associate, and advanced practice 20
registered nurse licensed under Title 18 RCW. 21
(21) "Secretary" means the secretary of social and health 22
services. 23
(22) "Whole-person care in behavioral health" means a health care 24
integration model in which primary care services are integrated into 25
a behavioral health setting either through colocation or community-26
based care management. 27
Sec. 130. RCW 74.09.328 and 2023 c 51 s 39 are each amended to 28
read as follows: 29
(1) In order to protect patients and ensure that they benefit 30
from seamless quality care when contracted providers are absent from 31
their practices or when there is a temporary vacancy in a position 32
while a hospital, rural health clinic, or rural provider is 33
recruiting to meet patient demand, hospitals, rural health clinics, 34
and rural providers may use substitute providers to provide services. 35
Medicaid managed care organizations must allow for the use of 36
substitute providers and provide payment consistent with the 37
provisions in this section. 38
p. 237 HB 2127
(2) Hospitals, rural health clinics, and rural providers that are 1
contracted with a medicaid managed care organization may use 2
substitute providers that are not contracted with a managed care 3
organization when: 4
(a) A contracted provider is absent for a limited period of time 5
due to vacation, illness, disability, continuing medical education, 6
or other short-term absence; or 7
(b) A contracted hospital, rural health clinic, or rural provider 8
is recruiting to fill an open position. 9
(3) For a substitute provider providing services under subsection 10
(2)(a) of this section, a contracted hospital, rural health clinic, 11
or rural provider may bill and receive payment for services at the 12
contracted rate under its contract with the managed care organization 13
for up to sixty days. 14
(4) To be eligible for reimbursement under this section for 15
services provided on behalf of a contracted provider for greater than 16
sixty days, a substitute provider must enroll in a medicaid managed 17
care organization. Enrollment of a substitute provider in a medicaid 18
managed care organization is effective on the later of:19
(a) The date the substitute provider filed an enrollment 20
application that was subsequently approved; or 21
(b) The date the substitute provider first began providing 22
services at the hospital, rural health clinic, or rural provider.23
(5) A substitute provider who enrolls with a medicaid managed 24
care organization may not bill under subsection (4) of this section 25
for any services billed to the medicaid managed care organization 26
pursuant to subsection (3) of this section. 27
(6) Nothing in this section obligates a managed care organization 28
to enroll any substitute provider who requests enrollment if they do 29
not meet the organizations enrollment criteria. 30
(7) For purposes of this section: 31
(a) "Circumstances precluded enrollment" means that the provider 32
has met all program requirements including state licensure during the 33
thirty-day period before an application was submitted and no final 34
adverse determination precluded enrollment. If a final adverse 35
determination precluded enrollment during this thirty-day period, the 36
contractor shall only establish an effective billing date the day 37
after the date that the final adverse action was resolved, as long as 38
it is not more than thirty days prior to the date on which the 39
application was submitted. 40
p. 238 HB 2127
(b) "Contracted provider" means a provider who is contracted with 1
a medicaid managed care organization. 2
(c) "Hospital" means a facility licensed under chapter 70.41 or 3
71.12 RCW. 4
(d) "Rural health clinic" means a federally designated rural 5
health clinic. 6
(e) "Rural provider" means physicians licensed under chapter 7
18.71 RCW, osteopathic physicians and surgeons licensed under chapter 8
18.57 RCW, podiatric physicians and surgeons licensed under chapter 9
18.22 RCW, physician ((assistants)) associates licensed under chapter 10
18.71A RCW, ((osteopathic physician assistants licensed under chapter 11
18.71A RCW,)) and advanced practice registered nurse s 12
((practitioners)) licensed under chapter 18.79 RCW, who are located 13
in a rural county as defined in RCW 82.14.370. 14
(f) "Substitute provider" includes physicians licensed under 15
chapter 18.71 RCW, osteopathic physicians and surgeons licensed under 16
chapter 18.57 RCW, podiatric physicians and surgeons licensed under 17
chapter 18.22 RCW, physician ((assistants)) associates licensed under 18
chapter 18.71A RCW, ((osteopathic physician assistants licensed under 19
chapter 18.71A RCW,)) and advanced practice registered nurse s 20
((practitioners)) licensed under chapter 18.79 RCW.21
Sec. 131. RCW 74.09.497 and 2024 c 62 s 31 are each amended to 22
read as follows: 23
(1) By August 1, 2017, the authority must complete a review of 24
payment codes available to health plans and providers related to 25
primary care and behavioral health. The review must include 26
adjustments to payment rules if needed to facilitate bidirectional 27
integration. The review must involve stakeholders and include 28
consideration of the following principles to the extent allowed by 29
federal law: 30
(a) Payment rules must allow professionals to operate within the 31
full scope of their practice; 32
(b) Payment rules should allow medically necessary behavioral 33
health services for covered patients to be provided in any setting;34
(c) Payment rules should allow medically necessary primary care 35
services for covered patients to be provided in any setting;36
(d) Payment rules and provider communications related to payment 37
should facilitate integration of physical and behavioral health 38
services through multifaceted models, including primary care 39
p. 239 HB 2127
behavioral health, whole-person care in behavioral health, 1
collaborative care, and other models; 2
(e) Payment rules should be designed liberally to encourage 3
innovation and ease future transitions to more integrated models of 4
payment and more integrated models of care; 5
(f) Payment rules should allow health and behavior codes to be 6
reimbursed for all patients in primary care settings as provided by 7
any licensed behavioral health professional operating within their 8
scope of practice, including but not limited to psychiatrists, 9
psychologists, psychiatric advanced registered nurse professionals, 10
physician ((assistants)) associates working with a psychiatrist who 11
is acting as a participating physician as defined in RCW 18.71A.010, 12
psychiatric nurses, mental health counselors, social workers, 13
chemical dependency professionals, chemical dependency professional 14
trainees, marriage and family therapists, and mental health counselor 15
associates under the supervision of a licensed clinician;16
(g) Payment rules should allow health and behavior codes to be 17
reimbursed for all patients in behavioral health settings as provided 18
by any licensed health care provider within the provider's scope of 19
practice; 20
(h) Payment rules which limit same-day billing for providers 21
using the same provider number, require prior authorization for low-22
level or routine behavioral health care, or prohibit payment when the 23
patient is not present should be implemented only when consistent 24
with national coding conventions and consonant with accepted best 25
practices in the field. 26
(2) Concurrent with the review described in subsection (1) of 27
this section, the authority must create matrices listing the 28
following codes available for provider payment through medical 29
assistance programs: All behavioral health-related codes; and all 30
physical health-related codes available for payment when provided in 31
licensed behavioral health agencies. The authority must clearly 32
explain applicable payment rules in order to increase awareness among 33
providers, standardize billing practices, and reduce common and 34
avoidable billing errors. The authority must disseminate this 35
information in a manner calculated to maximally reach all relevant 36
plans and providers. The authority must update the provider billing 37
guide to maintain consistency of information. 38
(3) The authority must inform the governor and relevant 39
committees of the legislature by letter of the steps taken pursuant 40
p. 240 HB 2127
to this section and results achieved once the work has been 1
completed. 2
Sec. 132. RCW 74.09.725 and 2025 c 58 s 5168 are each amended to 3
read as follows: 4
The authority shall provide coverage for prostate cancer 5
screening under this chapter, provided that the screening is 6
delivered upon the recommendation of the patient's physician, 7
advanced practice registered nurse, or physician ((assistant)) 8
associate. 9
Sec. 133. RCW 74.42.010 and 2025 c 58 s 5169 are each amended to 10
read as follows: 11
Unless the context clearly requires otherwise, the definitions in 12
this section apply throughout this chapter. 13
(1) "Department" means the department of social and health 14
services and the department's employees. 15
(2) "Direct care staff" means the staffing domain identified and 16
defined in the centers for medicare and medicaid services' five-star 17
quality rating system and as reported through the centers for 18
medicare and medicaid services' payroll-based journal. For purposes 19
of calculating hours per resident day minimum staffing standards for 20
facilities with sixty-one or more licensed beds, the director of 21
nursing services classification (job title code five), as identified 22
in the centers for medicare and medicaid services' payroll-based 23
journal, shall not be used. For facilities with sixty or fewer beds 24
the director of nursing services classification (job title code five) 25
shall be included in calculating hours per resident day minimum 26
staffing standards. 27
(3) "Facility" refers to a nursing home as defined in RCW 28
18.51.010. 29
(4) "Geriatric behavioral health worker" means a person with a 30
bachelor's or master's degree in social work, behavioral health, or 31
other related areas, or a person who has received specialized 32
training devoted to mental illness and treatment of older adults.33
(5) "Licensed practical nurse" means a person licensed to 34
practice practical nursing under chapter 18.79 RCW.35
(6) "Medicaid" means Title XIX of the Social Security Act enacted 36
by the social security amendments of 1965 (42 U.S.C. Sec. 1396; 79 37
Stat. 343), as amended. 38
p. 241 HB 2127
(7) "Nurse practitioner" means a person licensed to practice 1
advanced practice registered nursing under chapter 18.79 RCW.2
(8) "Nursing care" means that care provided by a registered 3
nurse, an advanced practice registered nurse, a licensed practical 4
nurse, or a nursing assistant in the regular performance of their 5
duties. 6
(9) "Physician" means a person practicing pursuant to chapter 7
18.57 or 18.71 RCW, including, but not limited to, a physician 8
employed by the facility as provided in chapter 18.51 RCW.9
(10) "Physician ((assistant)) associate" means a person 10
practicing pursuant to chapter 18.71A RCW. 11
(11) "Qualified therapist" means: 12
(a) An activities specialist who has specialized education, 13
training, or experience specified by the department.14
(b) An audiologist who is eligible for a certificate of clinical 15
competence in audiology or who has the equivalent education and 16
clinical experience. 17
(c) A mental health professional as defined in chapter 71.05 RCW.18
(d) An intellectual disabilities professional who is a qualified 19
therapist or a therapist approved by the department and has 20
specialized training or one year experience in treating or working 21
with persons with intellectual or developmental disabilities.22
(e) An occupational therapist who is a graduate of a program in 23
occupational therapy or who has equivalent education or training.24
(f) A physical therapist as defined in chapter 18.74 RCW.25
(g) A social worker as defined in RCW 18.320.010(2).26
(h) A speech pathologist who is eligible for a certificate of 27
clinical competence in speech pathology or who has equivalent 28
education and clinical experience. 29
(12) "Registered nurse" means a person licensed to practice 30
registered nursing under chapter 18.79 RCW. 31
(13) "Resident" means an individual residing in a nursing home, 32
as defined in RCW 18.51.010. 33
Sec. 134. RCW 74.42.230 and 2025 c 58 s 5057 are each amended to 34
read as follows: 35
(1) The resident's attending or staff physician or authorized 36
practitioner approved by the attending physician shall order all 37
medications for the resident. The order may be oral or written and 38
shall continue in effect until discontinued by a physician or other 39
p. 242 HB 2127
authorized prescriber, unless the order is specifically limited by 1
time. An "authorized practitioner," as used in this section, is a 2
registered nurse under chapter 18.79 RCW when authorized by the state 3
board of nursing, a physician ((assistant)) associate under chapter 4
18.71A RCW when authorized by the Washington medical commission, or a 5
pharmacist under chapter 18.64 RCW when authorized by the pharmacy 6
quality assurance commission. 7
(2) An oral order shall be given only to a licensed nurse, 8
pharmacist, or another physician. The oral order shall be recorded 9
and physically or electronically signed immediately by the person 10
receiving the order. The attending physician shall sign the record of 11
the oral order in a manner consistent with good medical practice.12
(3) A licensed nurse, pharmacist, or another physician receiving 13
and recording an oral order may, if so authorized by the physician or 14
authorized practitioner, communicate that order to a pharmacy on 15
behalf of the physician or authorized practitioner. The order may be 16
communicated verbally by telephone, by facsimile manually signed by 17
the person receiving the order pursuant to subsection (2) of this 18
section, or by electronic transmission pursuant to RCW 69.41.055. The 19
communication of a resident's order to a pharmacy by a licensed 20
nurse, pharmacist, or another physician acting at the prescriber's 21
direction has the same force and effect as if communicated directly 22
by the delegating physician or authorized practitioner. Nothing in 23
this provision limits the authority of a licensed nurse, pharmacist, 24
or physician to delegate to an authorized agent, including but not 25
limited to delegation of operation of a facsimile machine by 26
credentialed facility staff, to the extent consistent with his or her 27
professional license. 28
NEW SECTION. Sec. 135. RCW 18.71A.140 (Licenses issued under 29
chapter 18.57A RCW) and 2020 c 80 s 10 are each repealed.30
NEW SECTION. Sec. 136. Sections 5 through 58, 60 through 101, 31
103 through 120, and 122 through 135 of this act take effect June 30, 32
2027.33
NEW SECTION. Sec. 137. Section 58 of this act expires October 34
1, 2035.35
p. 243 HB 2127
NEW SECTION. Sec. 138. Section 59 of this act takes effect 1
October 1, 2035.2
NEW SECTION. Sec. 139. Section 101 of this act expires when 3
section 102 of this act takes effect.4
NEW SECTION. Sec. 140. Section 102 of this act takes effect 5
when the contingency in section 26, chapter 433, Laws of 2023 takes 6
effect.7
NEW SECTION. Sec. 141. Section 120 of this act expires when 8
section 121 of this act takes effect.9
NEW SECTION. Sec. 142. Section 121 of this act takes effect 10
when the contingency in section 27, chapter 433, Laws of 2023 takes 11
effect.12
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