CERTIFICATION OF ENROLLMENT
SECOND SUBSTITUTE SENATE BILL 6228
Chapter 366, Laws of 2024
68th Legislature
2024 Regular Session
SUBSTANCE USE DISORDER TREATMENT—VARIOUS PROVISIONS
EFFECTIVE DATE: June 6, 2024
Passed by the Senate March 5, 2024 CERTIFICATE
Yeas 49 Nays 0
I, Sarah Bannister, Secretary of
the Senate of the State of
DENNY HECK Washington, do hereby certify that
President of the Senate the attached is SECOND SUBSTITUTE
SENATE BILL 6228 as passed by the
Senate and the House of
Representatives on the dates hereon
Passed by the House February 29, 2024 set forth.
Yeas 84 Nays 8
SARAH BANNISTER
LAURIE JINKINS
Secretary
Speaker of the House of
Representatives
Approved March 29, 2024 11:06 AM FILED
April 1, 2024
Secretary of State
JAY INSLEE State of Washington
Governor of the State of Washington
 SECOND SUBSTITUTE SENATE BILL 6228
AS AMENDED BY THE HOUSE
Passed Legislature - 2024 Regular Session
State of Washington 68th Legislature 2024 Regular Session
By Senate Ways & Means (originally sponsored by Senators Dhingra,
Hasegawa, Kuderer, Lovelett, Nobles, Randall, Shewmake, Valdez, and
C. Wilson)
READ FIRST TIME 02/05/24.
1 AN ACT Relating to treatment of substance use disorders; amending
2 RCW 71.24.037, 41.05.526, 48.43.761, 71.24.618, 43.70.250, 41.05.527,
3 48.43.762, and 42.56.360; adding new sections to chapter 71.24 RCW;
4 adding a new section to chapter 28B.20 RCW; adding a new section to
5 chapter 41.05 RCW; adding a new section to chapter 48.43 RCW; adding
6 a new section to chapter 71.05 RCW; adding a new section to chapter
7 74.09 RCW; creating new sections; and providing an expiration date.
8 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
9 NEW SECTION. Sec. 1. (1) The legislature finds that ensuring
10 that individuals with substance use disorders can enter into and
11 complete residential addiction treatment is an important public
12 policy objective. Substance use disorder providers forcing patients
13 to leave treatment prematurely and insurance authorization barriers
14 both present impediments to realizing this goal.
15 (2) The legislature further finds that patients with substance
16 use disorders should be provided information regarding and access to
17 the full panoply of treatment options for their condition, as would
18 be the case with any other life-threatening disease.
19 Pharmacotherapies are incredibly effective and severely underutilized
20 tools in the treatment of opioid use disorder and alcohol use
21 disorder. The federal food and drug administration has approved three
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 1 medications for the treatment of opioid use disorder and three
2 medications for the treatment of alcohol use disorder. Only 37
3 percent of individuals with opioid use disorder and nine percent of
4 individuals with alcohol use disorder receive medication to treat
5 their condition.
6 (3) Therefore, it is the intent of the legislature to reduce
7 forced patient discharges from residential addiction treatment, to
8 remove arbitrary insurance authorization barriers to residential
9 addiction treatment, and to ensure that patients with opioid use
10 disorder and alcohol use disorder receive access to care that is
11 consistent with clinical best practices.
12 NEW SECTION. Sec. 2. A new section is added to chapter 71.24
13 RCW to read as follows:
14 (1)(a) By October 1, 2024, each licensed or certified behavioral
15 health agency providing voluntary inpatient or residential substance
16 use disorder treatment services or withdrawal management services
17 shall submit to the department any policies that the agency maintains
18 regarding the transfer or discharge of a person without the person's
19 consent from a facility providing those services. The policies that
20 agencies must submit include any policies related to situations in
21 which the agency transfers or discharges a person without the
22 person's consent, therapeutic progressive disciplinary processes that
23 the agency maintains, and procedures to assure safe transfers and
24 discharges when a patient is discharged without the patient's
25 consent. Behavioral health agencies that do not maintain such
26 policies must provide an attestation to this effect.
27 (b) By April 1, 2025, the department shall adopt a model policy
28 for licensed or certified behavioral health agencies providing
29 voluntary inpatient or residential substance use disorder treatment
30 services or withdrawal management services to consider when adopting
31 policies related to the transfer or discharge of a person without the
32 person's consent from a facility providing those services. In
33 developing the model policy, the department shall consider the
34 policies submitted by agencies under (a) of this subsection and
35 establish factors to be used in making a decision to transfer or
36 discharge a person without the person's consent. Factors may include,
37 but are not limited to, the person's medical condition, the clinical
38 determination that the person no longer requires treatment or
39 withdrawal management services at the facility, the risk of physical
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 1 injury presented by the person to the person's self or to other
2 persons at the facility, the extent to which the person's behavior
3 risks the recovery goals of other persons at the facility, and the
4 extent to which the agency has applied a therapeutic progressive
5 disciplinary process. The model policy must include provisions
6 addressing the use of an appropriate therapeutic progressive
7 disciplinary process and procedures to assure safe transfers and
8 discharges of a patient who is discharged without the patient's
9 consent.
10 (2)(a) Beginning July 1, 2025, every licensed or certified
11 behavioral health agency providing voluntary inpatient or residential
12 substance use disorder treatment services or withdrawal management
13 services shall submit a report to the department for each instance in
14 which a person receiving services either: (i) Was transferred or
15 discharged from the facility by the agency without the person's
16 consent; or (ii) released the person's self from the facility prior
17 to a clinical determination that the person had completed treatment.
18 (b) The department shall adopt rules to implement the reporting
19 requirement under (a) of this subsection, using a standard form. The
20 rules must require that the agency provide a description of the
21 circumstances related to the person's departure from the facility,
22 including whether the departure was voluntary or involuntary, the
23 extent to which a therapeutic progressive disciplinary process was
24 applied, the patient's self-reported understanding of the reasons for
25 discharge, efforts that were made to avert the discharge, and efforts
26 that were made to establish a safe discharge plan prior to the
27 patient leaving the facility.
28 (3) Patient health care information contained in reports
29 submitted under subsection (2) of this section is exempt from
30 disclosure under RCW 42.56.360.
31 (4) This section does not apply to hospitals licensed under
32 chapter 70.41 RCW and psychiatric hospitals licensed under chapter
33 71.12 RCW.
34 NEW SECTION. Sec. 3. A new section is added to chapter 28B.20
35 RCW to read as follows:
36 The addictions, drug, and alcohol institute at the University of
37 Washington shall create a patient shared decision-making tool to
38 assist behavioral health and medical providers when discussing
39 medication treatment options for patients with alcohol use disorder.
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1 The institute shall distribute the tool to behavioral health and
2 medical providers and instruct them on ways to incorporate the use of
3 the tool into their practices. The institute shall conduct regular
4 evaluations of the tool and update the tool as necessary.
5 Sec. 4. RCW 71.24.037 and 2023 c 454 s 2 are each amended to
6 read as follows:
7 (1) The secretary shall license or certify any agency or facility
8 that: (a) Submits payment of the fee established under RCW 43.70.110
9 and 43.70.250; (b) submits a complete application that demonstrates
10 the ability to comply with requirements for operating and maintaining
11 an agency or facility in statute or rule; and (c) successfully
12 completes the prelicensure inspection requirement.
13 (2) The secretary shall establish by rule minimum standards for
14 licensed or certified behavioral health agencies that must, at a
15 minimum, establish: (a) Qualifications for staff providing services
16 directly to persons with mental disorders, substance use disorders,
17 or both; (b) the intended result of each service; and (c) the rights
18 and responsibilities of persons receiving behavioral health services
19 pursuant to this chapter and chapter 71.05 RCW. The secretary shall
20 provide for deeming of licensed or certified behavioral health
21 agencies as meeting state minimum standards as a result of
22 accreditation by a recognized behavioral health accrediting body
23 recognized and having a current agreement with the department.
24 (3) The department shall review reports or other information
25 alleging a failure to comply with this chapter or the standards and
26 rules adopted under this chapter and may initiate investigations and
27 enforcement actions based on those reports.
28 (4) The department shall conduct inspections of agencies and
29 facilities, including reviews of records and documents required to be
30 maintained under this chapter or rules adopted under this chapter.
31 (5) The department may suspend, revoke, limit, restrict, or
32 modify an approval, or refuse to grant approval, for failure to meet
33 the provisions of this chapter, or the standards adopted under this
34 chapter. RCW 43.70.115 governs notice of a license or certification
35 denial, revocation, suspension, or modification and provides the
36 right to an adjudicative proceeding.
37 (6) No licensed or certified behavioral health agency may
38 advertise or represent itself as a licensed or certified behavioral
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 1 health agency if approval has not been granted or has been denied,
2 suspended, revoked, or canceled.
3 (7) Licensure or certification as a behavioral health agency is
4 effective for one calendar year from the date of issuance of the
5 license or certification. The license or certification must specify
6 the types of services provided by the behavioral health agency that
7 meet the standards adopted under this chapter. Renewal of a license
8 or certification must be made in accordance with this section for
9 initial approval and in accordance with the standards set forth in
10 rules adopted by the secretary.
11 (8) Licensure or certification as a licensed or certified
12 behavioral health agency must specify the types of services provided
13 that meet the standards adopted under this chapter. Renewal of a
14 license or certification must be made in accordance with this section
15 for initial approval and in accordance with the standards set forth
16 in rules adopted by the secretary.
17 (9) The department shall develop a process by which a provider
18 may obtain dual licensure as an evaluation and treatment facility and
19 secure withdrawal management and stabilization facility.
20 (10) Licensed or certified behavioral health agencies may not
21 provide types of services for which the licensed or certified
22 behavioral health agency has not been certified. Licensed or
23 certified behavioral health agencies may provide services for which
24 approval has been sought and is pending, if approval for the services
25 has not been previously revoked or denied.
26 (11) The department periodically shall inspect licensed or
27 certified behavioral health agencies at reasonable times and in a
28 reasonable manner.
29 (12) Upon petition of the department and after a hearing held
30 upon reasonable notice to the facility, the superior court may issue
31 a warrant to an officer or employee of the department authorizing him
32 or her to enter and inspect at reasonable times, and examine the
33 books and accounts of, any licensed or certified behavioral health
34 agency refusing to consent to inspection or examination by the
35 department or which the department has reasonable cause to believe is
36 operating in violation of this chapter.
37 (13) The department shall maintain and periodically publish a
38 current list of licensed or certified behavioral health agencies.
39 (14) Each licensed or certified behavioral health agency shall
40 file with the department or the authority upon request, data,
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 1 statistics, schedules, and information the department or the
2 authority reasonably requires. A licensed or certified behavioral
3 health agency that without good cause fails to furnish any data,
4 statistics, schedules, or information as requested, or files
5 fraudulent returns thereof, may have its license or certification
6 revoked or suspended.
7 (15) The authority shall use the data provided in subsection (14)
8 of this section to evaluate each program that admits children to
9 inpatient substance use disorder treatment upon application of their
10 parents. The evaluation must be done at least once every twelve
11 months. In addition, the authority shall randomly select and review
12 the information on individual children who are admitted on
13 application of the child's parent for the purpose of determining
14 whether the child was appropriately placed into substance use
15 disorder treatment based on an objective evaluation of the child's
16 condition and the outcome of the child's treatment.
17 (16) Any settlement agreement entered into between the department
18 and licensed or certified behavioral health agencies to resolve
19 administrative complaints, license or certification violations,
20 license or certification suspensions, or license or certification
21 revocations may not reduce the number of violations reported by the
22 department unless the department concludes, based on evidence
23 gathered by inspectors, that the licensed or certified behavioral
24 health agency did not commit one or more of the violations.
25 (17) In cases in which a behavioral health agency that is in
26 violation of licensing or certification standards attempts to
27 transfer or sell the behavioral health agency to a family member, the
28 transfer or sale may only be made for the purpose of remedying
29 license or certification violations and achieving full compliance
30 with the terms of the license or certification. Transfers or sales to
31 family members are prohibited in cases in which the purpose of the
32 transfer or sale is to avoid liability or reset the number of license
33 or certification violations found before the transfer or sale. If the
34 department finds that the owner intends to transfer or sell, or has
35 completed the transfer or sale of, ownership of the behavioral health
36 agency to a family member solely for the purpose of resetting the
37 number of violations found before the transfer or sale, the
38 department may not renew the behavioral health agency's license or
39 certification or issue a new license or certification to the
40 behavioral health service provider.
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 1 (18) Every licensed or certified outpatient behavioral health
2 agency shall display the 988 crisis hotline number in common areas of
3 the premises and include the number as a calling option on any phone
4 message for persons calling the agency after business hours.
5 (19) Every licensed or certified inpatient or residential
6 behavioral health agency must include the 988 crisis hotline number
7 in the discharge summary provided to individuals being discharged
8 from inpatient or residential services.
9 (20)(a) Licensed or certified behavioral health agencies
10 providing voluntary inpatient or residential substance use disorder
11 treatment services or withdrawal management services:
12 (i) Must comply with the policy submission and mandatory
13 reporting requirements established in section 2 of this act; and
14 (ii) May not prohibit a person from receiving services at or
15 being admitted to the agency based solely on prior instances of the
16 person releasing the person's self from the facility prior to a
17 clinical determination that the person had completed treatment.
18 (b) This subsection (20) does not apply to hospi