CERTIFICATION OF ENROLLMENT
ENGROSSED SECOND SUBSTITUTE SENATE BILL 6251
Chapter 368, Laws of 2024
68th Legislature
2024 Regular Session
BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES—REGIONAL COORDINATION
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 ENGROSSED SECOND
SUBSTITUTE SENATE BILL 6251 as
passed by the Senate and the House
of Representatives on the dates
Passed by the House March 1, 2024 hereon set forth.
Yeas 95 Nays 0
SARAH BANNISTER
LAURIE JINKINS
Secretary
Speaker of the House of
Representatives
Approved March 29, 2024 11:08 AM FILED
April 1, 2024
Secretary of State
JAY INSLEE State of Washington
Governor of the State of Washington
 ENGROSSED SECOND SUBSTITUTE SENATE BILL 6251
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,
Keiser, Kuderer, Lovelett, Lovick, Nguyen, Nobles, Robinson, Saldaña,
Trudeau, Valdez, Wellman, C. Wilson, and J. Wilson)
READ FIRST TIME 02/05/24.
1 AN ACT Relating to coordination of regional behavioral health
2 crisis response services; amending RCW 71.24.045; reenacting and
3 amending RCW 71.24.025 and 71.24.890; and adding a new section to
4 chapter 71.24 RCW.
5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
6 NEW SECTION. Sec. 1. A new section is added to chapter 71.24
7 RCW to read as follows:
8 Behavioral health administrative services organizations shall use
9 their authorities under RCW 71.24.045 to establish coordination
10 within the behavioral health crisis response system in each regional
11 service area including, but not limited to, establishing
12 comprehensive protocols for dispatching mobile rapid response crisis
13 teams and community-based crisis teams. In furtherance of this:
14 (1) The behavioral health administrative services organization
15 may convene regional behavioral health crisis response system
16 partners and stakeholders within available resources for the purpose
17 of establishing clear regional protocols which memorialize
18 expectations, understandings, lines of communication, and strategies
19 for optimizing crisis response in the regional service area. The
20 regional protocols must describe how crisis response partners will
21 share information consistent with data-sharing requirements under RCW
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 1 71.24.890, including real-time information sharing between 988
2 contact hubs, regional crisis lines, or their successors, to create a
3 seamless delivery system that is person-centered;
4 (2) Behavioral health administrative services organizations shall
5 submit regional protocols created under subsection (1) of this
6 section to the authority for approval. If the authority does not
7 respond within 90 days of submission, the regional protocols shall be
8 considered approved until such time as the behavioral health
9 administrative services organization and the authority agree to
10 updated protocols. A behavioral health administrative services
11 organization must notify the authority by January 1, 2025, if it does
12 not intend to develop and submit regional protocols;
13 (3) A behavioral health administrative services organization may
14 recommend to the department the 988 contact hub or hubs which it
15 determines to be the best fit for partnership and implementation of
16 regional protocols in its regional service area among candidates
17 which are able to meet necessary state and federal requirements. The
18 988 contact hub or hubs recommended by the behavioral health
19 administrative services organization must be able to connect to the
20 culturally appropriate behavioral health crisis response services
21 established under this chapter;
22 (4) The department may designate additional 988 contact hubs
23 recommended by a behavioral health administrative services
24 organization within available resources and when the addition of more
25 hubs is consistent with the rules adopted under RCW 71.24.890 and a
26 need identified in regional protocols. If the department declines to
27 designate a 988 contact hub that has been recommended by a behavioral
28 health administrative services organization, the department shall
29 provide a written explanation of its reasons to the behavioral health
30 administrative services organization;
31 (5) The department and the authority shall provide support to a
32 behavioral health administrative services organization in the
33 development of protocols under subsection (1) of this section upon
34 request by the behavioral health administrative services
35 organization;
36 (6) Regional protocols established under subsection (1) of this
37 section must be in writing and, once approved, copies shall be
38 provided to the department, authority, and state 911 coordination
39 office. The regional protocols should be updated as needed and at
40 intervals of no longer than three years; and
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 1 (7) For the purpose of subsection (1) of this section, partners
2 and stakeholders in the coordinated regional behavioral health crisis
3 response system include but are not limited to regional crisis lines,
4 988 contact hubs, certified public safety telecommunicators, local
5 governments, tribal governments, first responders, co-response teams,
6 mobile rapid response crisis teams, hospitals, organizations
7 representing persons with lived experience, and behavioral health
8 agencies.
9 Sec. 2. RCW 71.24.025 and 2023 c 454 s 1 and 2023 c 433 s 1 are
10 each reenacted and amended to read as follows:
11 Unless the context clearly requires otherwise, the definitions in
12 this section apply throughout this chapter.
13 (1) "23-hour crisis relief center" means a community-based
14 facility or portion of a facility serving adults, which is licensed
15 or certified by the department of health and open 24 hours a day,
16 seven days a week, offering access to mental health and substance use
17 care for no more than 23 hours and 59 minutes at a time per patient,
18 and which accepts all behavioral health crisis walk-ins drop-offs
19 from first responders, and individuals referred through the 988
20 system regardless of behavioral health acuity, and meets the
21 requirements under RCW 71.24.916.
22 (2) "988 crisis hotline" means the universal telephone number
23 within the United States designated for the purpose of the national
24 suicide prevention and mental health crisis hotline system operating
25 through the national suicide prevention lifeline.
26 (3) "Acutely mentally ill" means a condition which is limited to
27 a short-term severe crisis episode of:
28 (a) A mental disorder as defined in RCW 71.05.020 or, in the case
29 of a child, as defined in RCW 71.34.020;
30 (b) Being gravely disabled as defined in RCW 71.05.020 or, in the
31 case of a child, a gravely disabled minor as defined in RCW
32 71.34.020; or
33 (c) Presenting a likelihood of serious harm as defined in RCW
34 71.05.020 or, in the case of a child, as defined in RCW 71.34.020.
35 (4) "Alcoholism" means a disease, characterized by a dependency
36 on alcoholic beverages, loss of control over the amount and
37 circumstances of use, symptoms of tolerance, physiological or
38 psychological withdrawal, or both, if use is reduced or discontinued,
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 1 and impairment of health or disruption of social or economic
2 functioning.
3 (5) "Approved substance use disorder treatment program" means a
4 program for persons with a substance use disorder provided by a
5 treatment program licensed or certified by the department as meeting
6 standards adopted under this chapter.
7 (6) "Authority" means the Washington state health care authority.
8 (7) "Available resources" means funds appropriated for the
9 purpose of providing community behavioral health programs, federal
10 funds, except those provided according to Title XIX of the Social
11 Security Act, and state funds appropriated under this chapter or
12 chapter 71.05 RCW by the legislature during any biennium for the
13 purpose of providing residential services, resource management
14 services, community support services, and other behavioral health
15 services. This does not include funds appropriated for the purpose of
16 operating and administering the state psychiatric hospitals.
17 (8) "Behavioral health administrative services organization"
18 means an entity contracted with the authority to administer
19 behavioral health services and programs under RCW 71.24.381,
20 including crisis services and administration of chapter 71.05 RCW,
21 the involuntary treatment act, for all individuals in a defined
22 regional service area.
23 (9) "Behavioral health aide" means a counselor, health educator,
24 and advocate who helps address individual and community-based
25 behavioral health needs, including those related to alcohol, drug,
26 and tobacco abuse as well as mental health problems such as grief,
27 depression, suicide, and related issues and is certified by a
28 community health aide program of the Indian health service or one or
29 more tribes or tribal organizations consistent with the provisions of
30 25 U.S.C. Sec. 1616l and RCW 43.71B.010 (7) and (8).
31 (10) "Behavioral health provider" means a person licensed under
32 chapter 18.57, 18.71, 18.71A, 18.83, 18.205, 18.225, or 18.79 RCW, as
33 it applies to registered nurses and advanced registered nurse
34 practitioners.
35 (11) "Behavioral health services" means mental health services,
36 substance use disorder treatment services, and co-occurring disorder
37 treatment services as described in this chapter and chapter 71.36 RCW
38 that, depending on the type of service, are provided by licensed or
39 certified behavioral health agencies, behavioral health providers, or
40 integrated into other health care providers.
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 1 (12) "Child" means a person under the age of eighteen years.
2 (13) "Chronically mentally ill adult" or "adult who is
3 chronically mentally ill" means an adult who has a mental disorder
4 and meets at least one of the following criteria:
5 (a) Has undergone two or more episodes of hospital care for a
6 mental disorder within the preceding two years; or
7 (b) Has experienced a continuous psychiatric hospitalization or
8 residential treatment exceeding six months' duration within the
9 preceding year; or
10 (c) Has been unable to engage in any substantial gainful activity
11 by reason of any mental disorder which has lasted for a continuous
12 period of not less than twelve months. "Substantial gainful activity"
13 shall be defined by the authority by rule consistent with Public Law
14 92-603, as amended.
15 (14) "Clubhouse" means a community-based program that provides
16 rehabilitation services and is licensed or certified by the
17 department.
18 (15) "Community behavioral health program" means all
19 expenditures, services, activities, or programs, including reasonable
20 administration and overhead, designed and conducted to prevent or
21 treat substance use disorder, mental illness, or both in the
22 community behavioral health system.
23 (16) "Community behavioral health service delivery system" means
24 public, private, or tribal agencies that provide services
25 specifically to persons with mental disorders, substance use
26 disorders, or both, as defined under RCW 71.05.020 and receive
27 funding from public sources.
28 (17) "Community support services" means services authorized,
29 planned, and coordinated through resource management services
30 including, at a minimum, assessment, diagnosis, emergency crisis
31 intervention available twenty-four hours, seven days a week,
32 prescreening determinations for persons who are mentally ill being
33 considered for placement in nursing homes as required by federal law,
34 screening for patients being considered for admission to residential
35 services, diagnosis and treatment for children who are acutely
36 mentally ill or severely emotionally or behaviorally disturbed
37 discovered under screening through the federal Title XIX early and
38 periodic screening, diagnosis, and treatment program, investigation,
39 legal, and other nonresidential services under chapter 71.05 RCW,
40 case management services, psychiatric treatment including medication
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 1 supervision, counseling, psychotherapy, assuring transfer of relevant
2 patient information between service providers, recovery services, and
3 other services determined by behavioral health administrative
4 services organizations.
5 (18) "Community-based crisis team" means a team that is part of
6 an emergency medical services agency, a fire service agency, a public
7 health agency, a medical facility, a nonprofit crisis response
8 provider, or a city or county government entity, other than a law
9 enforcement agency, that provides the on-site community-based
10 interventions of a mobile rapid response crisis team for individuals
11 who are experiencing a behavioral health crisis.
12 (19) "Consensus-based" means a program or practice that has
13 general support among treatment providers and experts, based on
14 experience or professional literature, and may have anecdotal or case
15 study support, or that is agreed but not possible to perform studies
16 with random assignment and controlled groups.
17 (20) "County authority" means the board of county commissioners,
18 county council, or county executive having authority to establish a
19 behavioral health administrative services organization, or two or
20 more of the county authorities specified in this subsection which
21 have entered into an agreement to establish a behavioral health
22 administrative services organization.
23 (21) "Crisis stabilization services" means services such as 23-
24 hour crisis relief centers, crisis stabilization units, short-term
25 respite facilities, peer-run respite services, and same-day walk-in
26 behavioral health services, including within the overall crisis
27 system components that operate like hospital emergency departments
28 that accept all walk-ins, and ambulance, fire, and police drop-offs,
29 or determine the need for involuntary hospitalization of an
30 individual.
31 (22) "Crisis stabilization unit" has the same meaning as under
32 RCW 71.05.020.
33 (23) "Department" means the department of health.
34 (24) "Designated 988 contact hub" or "988 contact hub" means a
35 state-designated contact center that streamlines clinical
36 interventions and access to resources for people experiencing a
37 behavioral health crisis and participates in the national suicide
38 prevention lifeline network to respond to statewide or regional 988
39 contacts that meets the requirements of RCW 71.24.890.
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 1 (25) "Designated crisis responder" has the same meaning as in RCW
2 71.05.020.
3 (26) "Director" means the director of the authority.
4 (27) "Drug addiction" means a disease characterized by a
5 dependency on psychoactive chemicals, loss of control over the amount
6 and circumstances of use, symptoms of tolerance, physiological or
7 psychological withdrawal, or both, if use is reduced or discontinued,
8 and impairment of health or disruption of social or economic
9 functioning.
10 (28) "Early adopter" means a regional service area for which all
11 of the county authorities have requested that the authority purchase
12 medical and behavioral health services through a managed care health
13 system as defined under RCW 71.24.380(7).
14 (29) "Emerging best practice" or "promising practice" means a
15 program or practice that, based on statistical analyses or a well
16 established theory of change, shows potential for meeting the
17 evidence-based or research-based criteria, which may include the use
18 of a program that is evidence-based for outcomes other than those
19 listed in subsection (30) of this section.
20 (30) "Evidence-based" means a program or practice that has been
21 tested in heterogeneous or intended populations with multiple
22 randomized, or statistically controlled evaluations, or both; or one
23 large multiple sit