CERTIFICATION OF ENROLLMENT
ENGROSSED SECOND SUBSTITUTE HOUSE BILL 1477
Chapter 302, Laws of 2021
67th Legislature
2021 Regular Session
NATIONAL 988 SYSTEM
EFFECTIVE DATE: July 25, 2021—Except for section 103, which takes
effect May 13, 2021; sections 201 through 205, which take effect
October 1, 2021; and section 402, which takes effect July 1, 2022.
Passed by the House April 24, 2021 CERTIFICATE
Yeas 71 Nays 25
I, Bernard Dean, Chief Clerk of the
House of Representatives of the
LAURIE JINKINS State of Washington, do hereby
Speaker of the House of certify that the attached is
Representatives ENGROSSED SECOND SUBSTITUTE HOUSE
BILL 1477 as passed by the House of
Representatives and the Senate on
the dates hereon set forth.
Passed by the Senate April 24, 2021
Yeas 27 Nays 22
BERNARD DEAN
DENNY HECK Chief Clerk
President of the Senate
Approved May 13, 2021 11:49 AM FILED
May 13, 2021
Secretary of State
JAY INSLEE State of Washington
Governor of the State of Washington
 ENGROSSED SECOND SUBSTITUTE HOUSE BILL 1477
AS RECOMMENDED BY THE CONFERENCE COMMITTEE
Passed Legislature - 2021 Regular Session
State of Washington 67th Legislature 2021 Regular Session
By House Appropriations (originally sponsored by Representatives
Orwall, Davis, Ortiz-Self, Callan, Simmons, J. Johnson, Goodman, Ryu,
Ormsby, Valdez, Frame, Berg, Bergquist, Harris-Talley, Chopp, Macri,
Peterson, and Pollet)
READ FIRST TIME 02/22/21.
1 AN ACT Relating to the implementation of the national 988 system
2 to enhance and expand behavioral health crisis response and suicide
3 prevention services statewide by imposing an excise tax on certain
4 telecommunications services; amending RCW 71.24.649; reenacting and
5 amending RCW 71.24.025 and 71.24.025; adding new sections to chapter
6 71.24 RCW; adding a new section to chapter 48.43 RCW; adding a new
7 section to chapter 43.06 RCW; adding a new chapter to Title 82 RCW;
8 creating a new section; prescribing penalties; making appropriations;
9 providing effective dates; providing expiration dates; and declaring
10 an emergency.
11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
12 PART I
13 CRISIS CALL CENTER HUBS AND CRISIS SERVICES
14 NEW SECTION. Sec. 101. (1) The legislature finds that:
15 (a) Nearly 6,000 Washington adults and children died by suicide
16 in the last five years, according to the federal centers for disease
17 control and prevention, tragically reflecting a state increase of 36
18 percent in the last 10 years.
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 1 (b) Suicide is now the single leading cause of death for
2 Washington young people ages 10 through 24, with total deaths 22
3 percent higher than for vehicle crashes.
4 (c) Groups with suicide rates higher than the general population
5 include veterans, American Indians/Alaska Natives, LGBTQ youth, and
6 people living in rural counties across the state.
7 (d) More than one in five Washington residents are currently
8 living with a behavioral health disorder.
9 (e) The COVID-19 pandemic has increased stressors and substance
10 use among Washington residents.
11 (f) An improved crisis response system will reduce reliance on
12 emergency room services and the use of law enforcement response to
13 behavioral health crises and will stabilize individuals in the
14 community whenever possible.
15 (g) To accomplish effective crisis response and suicide
16 prevention, Washington state must continue its integrated approach to
17 address mental health and substance use disorder in tandem under the
18 umbrella of behavioral health disorders, consistently with chapter
19 71.24 RCW and the state's approach to integrated health care. This is
20 particularly true in the domain of suicide prevention, because of the
21 prevalence of substance use as both a risk factor and means for
22 suicide.
23 (2) The legislature intends to:
24 (a) Establish crisis call center hubs and expand the crisis
25 response system in a deliberate, phased approach that includes the
26 involvement of partners from a range of perspectives to:
27 (i) Save lives by improving the quality of and access to
28 behavioral health crisis services;
29 (ii) Further equity in addressing mental health and substance use
30 treatment and assure a culturally and linguistically competent
31 response to behavioral health crises;
32 (iii) Recognize that, historically, crisis response placed
33 marginalized communities, including those experiencing behavioral
34 health crises, at disproportionate risk of poor outcomes and criminal
35 justice involvement;
36 (iv) Comply with the national suicide hotline designation act of
37 2020 and the federal communications commission's rules adopted July
38 16, 2020, to assure that all Washington residents receive a
39 consistent and effective level of 988 suicide prevention and other
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 1 behavioral health crisis response and suicide prevention services no
2 matter where they live, work, or travel in the state; and
3 (v) Provide higher quality support for people experiencing
4 behavioral health crises through investment in new technology to
5 create a crisis call center hub system to triage calls and link
6 individuals to follow-up care.
7 (b) Make additional investments to enhance the crisis response
8 system, including the expansion of crisis teams, to be known as
9 mobile rapid response crisis teams, and deployment of a wide array of
10 crisis stabilization services, such as 23-hour crisis stabilization
11 units based on the living room model, crisis stabilization centers,
12 short-term respite facilities, peer-run respite centers, and same-day
13 walk-in behavioral health services. The overall crisis system shall
14 contain components that operate like hospital emergency departments
15 that accept all walk-ins and ambulance, fire, and police drop-offs.
16 Certified peer counselors as well as peers in other roles providing
17 support must be incorporated within the crisis system and along the
18 continuum of crisis care.
19 NEW SECTION. Sec. 102. A new section is added to chapter 71.24
20 RCW to read as follows:
21 (1) Establishing the state crisis call center hubs and enhancing
22 the crisis response system will require collaborative work between
23 the department and the authority within their respective roles. The
24 department shall have primary responsibility for establishing and
25 designating the crisis call center hubs. The authority shall have
26 primary responsibility for developing and implementing the crisis
27 response system and services to support the work of the crisis call
28 center hubs. In any instance in which one agency is identified as the
29 lead, the expectation is that agency will be communicating and
30 collaborating with the other to ensure seamless, continuous, and
31 effective service delivery within the statewide crisis response
32 system.
33 (2) The department shall provide adequate funding for the state's
34 crisis call centers to meet an expected increase in the use of the
35 call centers based on the implementation of the 988 crisis hotline.
36 The funding level shall be established at a level anticipated to
37 achieve an in-state call response rate of at least 90 percent by July
38 22, 2022. The funding level shall be determined by considering
39 standards and cost per call predictions provided by the administrator
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 1 of the national suicide prevention lifeline, call volume predictions,
2 guidance on crisis call center performance metrics, and necessary
3 technology upgrades.
4 (3) The department shall adopt rules by July 1, 2023, to
5 establish standards for designation of crisis call centers as crisis
6 call center hubs. The department shall collaborate with the authority
7 and other agencies to assure coordination and availability of
8 services, and shall consider national guidelines for behavioral
9 health crisis care as determined by the federal substance abuse and
10 mental health services administration, national behavioral health
11 accrediting bodies, and national behavioral health provider
12 associations to the extent they are appropriate, and recommendations
13 from the crisis response improvement strategy committee created in
14 section 103 of this act.
15 (4) The department shall designate crisis call center hubs by
16 July 1, 2024. The crisis call center hubs shall provide crisis
17 intervention services, triage, care coordination, referrals, and
18 connections to individuals contacting the 988 crisis hotline from any
19 jurisdiction within Washington 24 hours a day, seven days a week,
20 using the system platform developed under subsection (5) of this
21 section.
22 (a) To be designated as a crisis call center hub, the applicant
23 must demonstrate to the department the ability to comply with the
24 requirements of this section and to contract to provide crisis call
25 center hub services. The department may revoke the designation of any
26 crisis call center hub that fails to substantially comply with the
27 contract.
28 (b) The contracts entered shall require designated crisis call
29 center hubs to:
30 (i) Have an active agreement with the administrator of the
31 national suicide prevention lifeline for participation within its
32 network;
33 (ii) Meet the requirements for operational and clinical standards
34 established by the department and based upon the national suicide
35 prevention lifeline best practices guidelines and other recognized
36 best practices;
37 (iii) Employ highly qualified, skilled, and trained clinical
38 staff who have sufficient training and resources to provide empathy
39 to callers in acute distress, de-escalate crises, assess behavioral
40 health disorders and suicide risk, triage to system partners, and
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 1 provide case management and documentation. Call center staff shall be
2 trained to make every effort to resolve cases in the least
3 restrictive environment and without law enforcement involvement
4 whenever possible. Call center staff shall coordinate with certified
5 peer counselors to provide follow-up and outreach to callers in
6 distress as available. It is intended for transition planning to
7 include a pathway for continued employment and skill advancement as
8 needed for experienced crisis call center employees;
9 (iv) Collaborate with the authority, the national suicide
10 prevention lifeline, and veterans crisis line networks to assure
11 consistency of public messaging about the 988 crisis hotline; and
12 (v) Provide data and reports and participate in evaluations and
13 related quality improvement activities, according to standards
14 established by the department in collaboration with the authority.
15 (c) The department and the authority shall incorporate
16 recommendations from the crisis response improvement strategy
17 committee created under section 103 of this act in its agreements
18 with crisis call center hubs, as appropriate.
19 (5) The department and authority must coordinate to develop the
20 technology and platforms necessary to manage and operate the
21 behavioral health crisis response and suicide prevention system. The
22 technologies developed must include:
23 (a) A new technologically advanced behavioral health and suicide
24 prevention crisis call center system platform using technology
25 demonstrated to be interoperable across crisis and emergency response
26 systems used throughout the state, such as 911 systems, emergency
27 medical services systems, and other nonbehavioral health crisis
28 services, for use in crisis call center hubs designated by the
29 department under subsection (4) of this section. This platform, which
30 shall be fully funded by July 1, 2023, shall be developed by the
31 department and must include the capacity to receive crisis assistance
32 requests through phone calls, texts, chats, and other similar methods
33 of communication that may be developed in the future that promote
34 access to the behavioral health crisis system; and
35 (b) A behavioral health integrated client referral system capable
36 of providing system coordination information to crisis call center
37 hubs and the other entities involved in behavioral health care. This
38 system shall be developed by the authority.
39 (6) In developing the new technologies under subsection (5) of
40 this section, the department and the authority must coordinate to
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 1 designate a primary technology system to provide each of the
2 following:
3 (a) Access to real-time information relevant to the coordination
4 of behavioral health crisis response and suicide prevention services,
5 including:
6 (i) Real-time bed availability for all behavioral health bed
7 types, including but not limited to crisis stabilization services,
8 triage facilities, psychiatric inpatient, substance use disorder
9 inpatient, withdrawal management, peer-run respite centers, and
10 crisis respite services, inclusive of both voluntary and involuntary
11 beds, for use by crisis response workers, first responders, health
12 care providers, emergency departments, and individuals in crisis; and
13 (ii) Real-time information relevant to the coordination of
14 behavioral health crisis response and suicide prevention services for
15 a person, including the means to access:
16 (A) Information about any less restrictive alternative treatment
17 orders or mental health advance directives related to the person; and
18 (B) Information necessary to enable the crisis call center hub to
19 actively collaborate with emergency departments, primary care
20 providers and behavioral health providers within managed care
21 organizations, behavioral health administrative services
22 organizations, and other health care payers to establish a safety
23 plan for the person in accordance with best practices and provide the
24 next steps for the person's transition to follow-up noncrisis care.
25 To establish information-sharing guidelines that fulfill the intent
26 of this section the authority shall consider input from the
27 confidential information compliance and coordination subcommittee
28 established under section 103 of this act;
29 (b) The means to request deployment of appropriate crisis
30 response services, which may include mobile rapid response crisis
31 teams, co-responder teams, designated crisis responders, fire
32 department mobile integrated health teams, or community assistance
33 referral and educational services programs under RCW 35.21.930,
34 according to best practice guidelines established by the authority,
35 and track local response through global positioning technology; and
36 (c) The means to track the outcome of the 988 call to enable
37 appropriate follow up, cross-system coordination, and accountability,
38 including as appropriate: (i) Any immediate services dispatched and
39 reports generated from the encounter; (ii) the validation of a safety
40 plan established for the caller in accordance with best practices;
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 1 (iii) the next steps for the caller to follow in transition to
2 noncrisis follow-up care, including a next-day appointment for
3 callers experiencing urgent, symptomatic behavioral health care
4 needs; and (iv) the means to verify and document whether the caller
5 was successful in making the transition to appropriate noncrisis
6 follow-up care indicated in the safety plan for the person, to be
7 completed either by the care coordinator provided through the
8 person's managed care organization, health plan, or behavioral health
9 administrative services organization, or if such a care coordinator
10 is not available or does not follow through, by the staff of the
11 crisis call center hub;
12 (d) A means to facilitate actions to verify and document whether
13 the person's transition to follow up noncrisis care was completed and
14 services offered, to be performed by a care coordinator provided
15 through the person's managed care organization, health plan, or
16 behavioral health administrative services organization, or if such a
17 care coordinator is not available or does not follow through, by the
18 staff of the crisis call center hub;
19 (e) The means to provide geographically, culturally, and
20 linguistically appropriate services to persons who are part of high-
21 risk populations or otherwise have need of specialized services or
22 acco