The legislature finds that:
Nearly 6,000 Washington adults and children died by suicide in the last five years, according to the federal centers for disease control and prevention, tragically reflecting a state increase of 36 percent in the last 10 years.
Suicide is now the single leading cause of death for Washington young people ages 10 through 24, with total deaths 22 percent higher than for vehicle crashes.
Groups with suicide rates higher than the general population include veterans, American Indians/Alaska Natives, LGBTQ youth, and people living in rural counties across the state.
More than one in five Washington residents are currently living with a behavioral health disorder.
The COVID-19 pandemic has increased stressors and substance use among Washington residents.
An improved crisis response system will reduce reliance on emergency room services and the use of law enforcement response to behavioral health crises and will stabilize individuals in the community whenever possible.
The legislature intends to establish crisis call center hubs and expand the crisis delivery system in a deliberate, phased approach that includes the involvement of partners from a range of perspectives to:
Save lives by improving the quality of and access to behavioral health crisis services;
Further equity in addressing mental health and substance use treatment and assure a culturally and linguistically competent response to behavioral health crises;
Recognize that, historically, crisis response placed marginalized communities, including those experiencing behavioral health crises, at disproportionate risk of poor outcomes and criminal justice involvement;
Comply with the national suicide hotline designation act of 2020 and the federal communication commission's rules adopted July 16, 2020, to assure that all Washington residents receive a consistent and effective level of 988 and crisis behavioral health services no matter where they live, work, or travel in the state; and
Provide higher quality support for people experiencing behavioral health crises through investment in new technology to create a crisis call center hub system to triage calls and link individuals to follow-up care. Other investments include the expansion of crisis teams, to be known as mobile rapid response crisis teams, as well as a wide array of crisis stabilization services such as 23-hour crisis stabilization units based on the living room model, crisis stabilization centers, short-term respite facilities, peer-operated respite services, and behavioral health urgent care walk-in centers. The overall crisis system shall contain components that operate like hospital emergency departments that accept all walk-ins, and ambulance, fire, and police drop-offs. The use of peers must be incorporated as often as possible within the continuum of crisis care.
This section adds a new section to an existing chapter 71.24. Here is the modified chapter for context.
Establishing the state crisis call center hubs and crisis response system will require collaborative work between the department and the authority within their respective roles. The department shall have primary responsibility for establishing and designating the crisis call centers hubs. The authority shall have primary responsibility for developing and implementing the crisis system and services to support the work of the crisis call center hubs. In any instance in which one agency is identified as the lead, the expectation is that agency will be communicating and collaborating with the other to ensure seamless, continuous, and effective service delivery with the statewide crisis system.
Prior to July 16, 2022, the department shall provide adequate funding for an expected increase in the use of the state's crisis lifeline call centers existing as of the effective date of this section using the 988 crisis hotline. The funding level shall be established at a level anticipated to achieve an in-state call response rate of at least 90 percent and shall be determined by considering call volume predictions, cost per call predictions provided by the national suicide prevention lifeline, guidance on center performance metrics, and necessary technology upgrades.
By July 1, 2023, the department must adopt rules to establish standards that crisis call centers must meet to be designated as crisis call center hubs by the department as of July 1, 2024. The standards must, at a minimum, address the elements identified in subsection (4) of this section. The department shall collaborate with the authority and other agencies to assure consistency in standards and policies, and utilization of services. The department shall consider recommendations from the crisis response improvement strategy committee created in section 104 of this act in implementing this section.
No later than July 1, 2024, the department shall designate crisis call center hubs to provide crisis intervention, triage, referrals, and connections to individuals accessing the 988 crisis hotline from any jurisdiction within Washington 24 hours a day, seven days a week.
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To be recognized as a crisis call center hub and perform the duties of a crisis call center hub, an entity must be designated by the department under this subsection (4). To become designated and maintain that designation, a crisis call center hub must demonstrate to the department the ability to support the requirements of this section.
Upon being designated, a crisis call center hub shall contract with the department to provide crisis call center hub services, as described in this section. The department may revoke the designation of any crisis call center hub that fails to substantially comply with the contracts.
The department may incorporate recommendations from the crisis response improvement strategy committee created in section 104 of this act into the agreements with crisis call center hubs, as appropriate.
Subject to funds appropriated for this purpose, the authority, in collaboration with the department, must develop a new technologically advanced behavioral health crisis call center system with a platform that includes the capacity to:
Receive crisis assistance requests through phone calls, texts, chats, and other similar methods of communication that may be developed in the future and promote access to the behavioral health crisis system;
Access real-time information relevant to the appropriate coordination of behavioral health crisis services, including information about less restrictive alternatives and mental health advance directives, from managed care organizations, including both primary care providers and behavioral health providers within the networks of managed care organizations, behavioral health administrative service organizations, and other health care payers;
Assign and track local response to behavioral health crisis calls, including the capacity to rapidly deploy mobile crisis teams through global positioning technology;
Arrange next-day outpatient appointments and follow-up appointments with geographically, culturally, and linguistically appropriate primary care or behavioral health providers within the person's provider network, or, if uninsured, through the person's behavioral health administrative service organization;
Track and provide real-time bed availability to crisis responders and individuals in crisis for all behavioral health bed types, such as crisis stabilization, psychiatric inpatient, substance use disorder inpatient, withdrawal management, and peer crisis respite, including voluntary and involuntary beds; and
Assure follow-up services to individuals accessing the 988 crisis hotline consistent with policies established by the department based upon recognized best practices.
Crisis call center hubs must use the new technologically advanced behavioral health crisis call center system with the platform as described in this section.
To provide crisis intervention services and crisis care coordination using the platform capabilities required under (b) of this subsection, crisis call center hubs must:
Have an active agreement with the administrator of the national suicide prevention lifeline for participation within its network;
Meet the requirements and best practices guidelines for operational and clinical standards established by the department that are based upon the national suicide prevention lifeline requirements and other recognized best practices;
Provide data and reports and participate in evaluations and related quality improvement activities as required by the department, according to standards established in collaboration with the authority, for the 988 crisis hotline system;
Use technology that is demonstrated to be interoperable between and across crisis and emergency response systems used throughout the state, such as 911 systems, emergency medical services systems, and other nonbehavioral health crisis services, as well as the national suicide prevention lifeline;
To provide crisis care coordination using the platform capabilities required under (b) of this subsection, the authority must develop systems that will give crisis call centers the authority to:
Deploy crisis and outgoing services, including mobile crisis teams and coresponder teams according to guidelines and best practices established by the authority that are based upon recognized best practices, as applicable;
Actively collaborate with managed care organizations, including both primary care providers and behavioral health providers within the networks of managed care organizations, behavioral health administrative services organizations, and other health care payers to coordinate linkages for persons contacting the 988 crisis hotline with ongoing care needs, according to formal agreements established by the authority, upon consultation with county authorities;
Coordinate access to crisis receiving and stabilization services for individuals accessing the 988 crisis hotline through appropriate information sharing regarding availability of services, in accordance with information sharing rules established under (g) of this subsection; and
Meet the requirements set forth by the authority for serving high-risk and special populations, as identified by the federal substance abuse and mental health services administration, including training requirements and policies for transferring such callers to an appropriate specialized center or subnetwork within or external to the national suicide prevention lifeline network. Requirements for high-risk and special populations shall be established with the goal of promoting behavioral health equity for all populations specifically in regards to race, ethnicity, gender, socioeconomic status, sexual orientation, or geographic location. Appropriate referrals must provide linguistically and culturally competent care.
Crisis call center hubs must work in collaboration with the authority and the national suicide prevention lifeline and veterans crisis line networks for the purpose of assuring consistency of public messaging about the 988 crisis hotline.
The authority, in consultation with the department, must adopt rules as necessary to implement this section. The rules must allow appropriate information sharing and communication between and across crisis and emergency response systems for the purpose of real-time crisis care coordination including, but not limited to, deployment of crisis and outgoing services, follow-up care, and linked, flexible services specific to crisis response.
The department must collaborate with the state enhanced 911 coordination office, emergency management division, and military department to use technology that is demonstrated to be interoperable between the 988 crisis hotline system and crisis and emergency response systems used throughout the state, such as 911 systems, emergency medical services systems, and other nonbehavioral health crisis services, as well as the national suicide prevention lifeline, to assure cohesive interoperability, develop training programs and operations for both 911 public safety telecommunicators and crisis line workers, develop suicide assessment and intervention strategies, and establish efficient and equitable access to resources via crisis hotlines.
The department of health, in consultation with the health care authority, shall convene the 988 implementation team for the purpose of preparing for the successful transition of the state's call centers that are contracted with the national suicide prevention lifeline to the 988 crisis hotline.
The 988 implementation team shall consist of the following members:
A representative of the department of health, who shall serve as the chair of the 988 implementation team;
A representative of the health care authority;
A representative of the state enhanced 911 coordination office;
A representative from each call center in Washington that is contracted with the national suicide prevention lifeline;
A member with expertise in behavioral health crisis responses;
A member who is a person with lived experience with mental health conditions and interaction with the behavioral health crisis response system;
A member who is a person with lived experience with substance use disorder and interaction with the behavioral health crisis response system; and
A representative from the behavioral health crisis delivery system.
The 988 implementation team shall:
Provide guidance and consultation to the department of health in performing its responsibilities under section 102(2) of this act;
Assist in determining the necessary activities and resources required to achieve an in-state call response rate of at least 90 percent, including necessary staffing, training, and immediate technology needs; and
Review the adequacy of training for crisis hotline center personnel and, in coordination with the state enhanced 911 coordination office, for 911 public safety telecommunicators with respect to their interactions with the crisis hotline center.
Staff support for the 988 implementation team must be provided by the department of health.
The 988 implementation team shall report its findings and recommendations to the governor and the appropriate policy and fiscal committees of the legislature by January 1, 2022.
This section expires July 1, 2022.
The crisis response improvement strategy committee is established for the purpose of developing an integrated behavioral health crisis response system containing the elements described in subsection (4) of this section.
The office of financial management shall select a private entity to facilitate the proceedings and the development of findings and recommendations of the strategy committee. In addition, the entity shall serve as a liaison between agencies with responsibilities in the enhancement and expansion of behavioral health and suicide prevention crisis services as well as between the crisis response improvement strategy committee and the blue ribbon commission on the intersection of the criminal justice and behavioral health crisis systems established in the governor's executive order 21-02.
The crisis response improvement strategy committee shall consist of the following members appointed by the health care authority, unless otherwise noted:
A representative of the health care authority, who shall serve as the chair of the crisis response improvement strategy committee;
A representative of the department of health;
A representative of the state enhanced 911 coordination office;
A representative from each call center in Washington that is contracted with the national suicide prevention lifeline;
A member with expertise in behavioral health crisis responses;
A member who is a person with lived experience with mental health conditions and interaction with the behavioral health crisis response system;
A member who is a person with lived experience with substance use disorder and interaction with the behavioral health crisis response system;
A representative from the behavioral health crisis delivery system;
One member and one alternate member from each of the two largest caucuses of the senate, as appointed by the president of the senate;
One member and one alternate member from each of the two largest caucuses of the house of representatives, as appointed by the speaker of the house of representatives;
A representative of the American Indian health commission for Washington state;
A representative of behavioral health administrative services organizations; and
A representative of medicaid managed care organizations.
The crisis response improvement strategy committee shall identify barriers and make recommendations to implement and monitor the progress of the 988 crisis hotline in Washington and make recommendations on statewide improvement of behavioral health crisis response services. The implementation coalition must develop, review, and report on the following:
A comprehensive assessment of the behavioral health crisis services system, including an inventory of existing statewide and regional behavioral health crisis services and resources, the identification of statewide and regional insufficiencies in necessary behavioral health crisis services and resources to meet population needs, goals for the provision of statewide and regional behavioral health crisis services and resources, and potential funding sources for each element of the statewide and regional behavioral health crisis services and resources;
A recommended vision for an integrated crisis network in Washington that includes, but is not limited to: An integrated 988 crisis hotline and crisis call center hubs; mobile crisis response units for youth, adult, and geriatric populations; crisis stabilization facilities; an integrated involuntary treatment system; peer and respite services; and data resources;
Recommendations for ensuring equity in services for individuals of diverse cultures and in tribal, urban, and rural communities;
A work plan with timelines to implement local responses to calls to the 988 crisis hotline within Washington in accordance with the time frames required by the national suicide hotline designation act of 2020;
The necessary components of a new statewide, technologically advanced behavioral health crisis call center system with a platform, as described in section 102 of this act, for assigning and tracking response to behavioral health crisis calls and providing real-time bed availability to crisis responders;
The establishment of a system that requires behavioral health providers to maintain and update real-time information regarding the availability of behavioral health inpatient and residential bed availability, and outpatient appointment availability to the crisis call center system platform, as well as standards for hospitals providing mental health treatment to a person pursuant to a single bed certification issued under RCW 71.05.745 to similarly provide and maintain updated, real-time information regarding those persons;
A work plan with timelines to enhance and expand the availability of community-based mobile rapid response crisis teams in each behavioral health administrative services organization, including specialized teams to respond to the unique needs of youth, including American Indian and Alaska Native youth and LGBTQ youth, and geriatric populations, including older adults of color and older adults with comorbid dementia;
The identification of the behavioral health challenges that implementation of the 988 crisis hotline will address in addition to suicide response and mental health and substance use crises;
The development of a plan for the statewide equal distribution of crisis stabilization services and beds, peer respite services, and behavioral health urgent care;
Requirements for health plans, managed care organizations, and behavioral health administrative services organizations to include coverage to assign a care coordinator to and provide next day appointments for enrollees who seek services from the behavioral health crisis system;
The allocation of funding responsibilities among medicaid managed care organizations, commercial insurers, and behavioral health administrative services organizations;
The recommended composition of a statewide behavioral health crisis response oversight board for ongoing monitoring of the system and where this should be established; and
Cost estimates for each of the components recommended by the crisis response improvement strategy committee.
The crisis response improvement strategy committee may form subcommittees to focus on discrete topics to be addressed in the reporting requirements. The subcommittees may include participants who are not members of the steering committee, as necessary to provide expertise and professional and community perspectives.
The proceedings of the crisis response improvement strategy committee must be open to the public and invite testimony from a broad range of professional and community perspectives. The crisis response improvement strategy committee shall seek input from tribes, veterans, the LGBTQ community, and communities of color to determine how well the crisis response system is currently working and ways to improve the crisis response system.
Staff support for the crisis response improvement strategy committee must be provided by the private entity selected by the office of financial management.
Legislative members of the implementation coalition shall be reimbursed for travel expenses in accordance with RCW 44.04.120. Nonlegislative members are not entitled to be reimbursed for travel expenses if they are elected officials or are participating on behalf of an employer, governmental entity, or other organization. Any reimbursement for other nonlegislative members is subject to chapter 43.03 RCW.
The crisis response improvement strategy committee shall report its findings and recommendations of the items in subsection (4) of this section to the governor and the appropriate policy and fiscal committees of the legislature by January 1, 2023.
This section expires August 1, 2023.
This section adds a new section to an existing chapter 71.24. Here is the modified chapter for context.
The department and authority shall provide an annual report of the 988 crisis hotline's usage and call outcomes and crisis services inclusive of the mobile rapid response crisis teams and crisis stabilization services. The report must be submitted to the governor and the appropriate committees of the legislature each November beginning in 2023. The report must include information on the fund deposits and expenditures of the account created in section 205 of this act.
The department and authority shall coordinate with the department of revenue, and any other agency that is appropriated funding under the account created in section 205 of this act to develop and submit information to the federal communication's commission required for the completion of fee accountability reports pursuant to the national suicide hotline designation act of 2020.
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
"988 crisis hotline" has the same meaning as in RCW 71.24.025.
"Crisis call center hub" has the same meaning as in RCW 71.24.025.
"Fiscal growth factor" has the same meaning as in RCW 43.135.025.
The definitions in RCW 82.14B.020 apply to this chapter.
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A statewide 988 behavioral health crisis response line tax is imposed on the use of all radio access lines:
By subscribers whose place of primary use is located within the state in the amount set forth in (a)(ii) of this subsection (1) per month for each radio access line. The tax must be uniform for each radio access line under this subsection (1); and
By consumers whose retail transaction occurs within the state in the amount set forth in this subsection (1)(a)(ii) per retail transaction. The amount of tax must be uniform for each retail transaction under this subsection (1) and is as follows:
(A) Beginning October 1, 2021, through December 31, 2022, the tax rate is 30 cents for each radio access line;
(B) Beginning January 1, 2023, through June 30, 2024, the tax rate is 50 cents for each radio access line; and
(C) Beginning July 1, 2024, the tax rate is 75 cents for each radio access line.
b. The tax imposed under this subsection (1) must be remitted to the department by radio communications service companies, including those companies that resell radio access lines, and sellers of prepaid wireless telecommunications service, on a tax return provided by the department. Tax proceeds must be deposited by the treasurer into the statewide 988 behavioral health crisis response line account created in section 205 of this act.
c. For the purposes of this subsection (1), the retail transaction is deemed to occur at the location where the transaction is sourced under RCW 82.32.520(3)(c).
A statewide 988 behavioral health crisis response line tax is imposed on all interconnected voice over internet protocol service lines in the state. The amount of tax must be uniform for each line and must be levied on no more than the number of voice over internet protocol service lines on an account that is capable of simultaneous unrestricted outward calling to the public switched telephone network. The tax imposed under this subsection (2) must be remitted to the department by interconnected voice over internet protocol service companies on a tax return provided by the department. The amount of tax for each interconnected voice over internet protocol service line whose place of primary use is located in the state is as follows:
Beginning October 1, 2021, through December 31, 2022, the tax rate is 30 cents for an interconnected voice over internet protocol service line;
Beginning January 1, 2023, through June 30, 2024, the tax rate is 50 cents for an interconnected voice over internet protocol service line; and
Beginning July 1, 2024, the tax rate is 75 cents for an interconnected voice over internet protocol service line.
By March 1, 2025, and March 1st of each odd year thereafter, the department must revise the amount of the statewide 988 behavioral health crisis response line tax imposed by subsections (1) through (3) of this section for the upcoming biennium using the fiscal growth factor. The new statewide 988 behavioral health crisis response line tax amount shall be effective for the upcoming biennium starting July 1, 2025, or July 1st of each odd year thereafter.
Tax proceeds collected pursuant to this section must be deposited by the treasurer into the statewide 988 behavioral health crisis response line account created in section 205 of this act.
Except as provided otherwise in subsection (2) of this section:
The statewide 988 behavioral health crisis response line tax on radio access lines must be collected from the subscriber by the radio communications service company, including those companies that resell radio access lines, providing the radio access line to the subscriber, and the seller of prepaid wireless telecommunications services.
The statewide 988 behavioral health crisis response line tax on interconnected voice over internet protocol service lines must be collected from the subscriber by the interconnected voice over internet protocol service company providing the interconnected voice over internet protocol service line to the subscriber.
The statewide 988 behavioral health crisis response line tax on switched access lines must be collected from the subscriber by the local exchange company.
The amount of the tax must be stated separately on the billing statement which is sent to the subscriber.
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The statewide 988 behavioral health crisis response line tax imposed by this chapter must be collected from the consumer by the seller of a prepaid wireless telecommunications service for each retail transaction occurring in this state.
The department must transfer all tax proceeds remitted by a seller under this subsection (2) to the statewide 988 behavioral health crisis response line account created in section 205 of this act.
The taxes required by this subsection to be collected by the seller must be separately stated in any sales invoice or instrument of sale provided to the consumer.
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The statewide 988 behavioral health crisis response line tax imposed by this chapter must be paid by the subscriber to the radio communications service company providing the radio access line, the local exchange company, or the interconnected voice over internet protocol service company providing the interconnected voice over internet protocol service line.
Each radio communications service company, each local exchange company, and each interconnected voice over internet protocol service company, must collect from the subscriber the full amount of the taxes payable. The statewide 988 behavioral health crisis response line tax required by this chapter to be collected by a company or seller, are deemed to be held in trust by the company or seller until paid to the department. Any radio communications service company, local exchange company, or interconnected voice over internet protocol service company that appropriates or converts the tax collected to its own use or to any use other than the payment of the tax to the extent that the money collected is not available for payment on the due date as prescribed in this chapter is guilty of a gross misdemeanor.
If any radio communications service company, local exchange company, or interconnected voice over internet protocol service company fails to collect the statewide 988 behavioral health crisis response line tax or, after collecting the tax, fails to pay it to the department in the manner prescribed by this chapter, whether such failure is the result of its own act or the result of acts or conditions beyond its control, the company or seller is personally liable to the state for the amount of the tax, unless the company or seller has taken from the buyer in good faith documentation, in a form and manner prescribed by the department, stating that the buyer is not a subscriber or consumer or is otherwise not liable for the statewide 988 behavioral health crisis response line tax.
The amount of tax, until paid by the subscriber to the radio communications service company, local exchange company, the interconnected voice over internet protocol service company, or to the department, constitutes a debt from the subscriber to the company, or from the consumer to the seller. Any company or seller that fails or refuses to collect the tax as required with intent to violate the provisions of this chapter or to gain some advantage or benefit, either direct or indirect, and any subscriber or consumer who refuses to pay any tax due under this chapter is guilty of a misdemeanor. The statewide 988 behavioral health crisis response line tax required by this chapter to be collected by the radio communications service company, local exchange company, or interconnected voice over internet protocol service company must be stated separately on the billing statement that is sent to the subscriber.
If a subscriber has failed to pay to the radio communications service company, local exchange company, or interconnected voice over internet protocol service company, the statewide 988 behavioral health crisis response line tax imposed by this chapter and the company or seller has not paid the amount of the tax to the department, the department may, in its discretion, proceed directly against the subscriber or consumer for collection of the tax, in which case a penalty of 10 percent may be added to the amount of the tax for failure of the subscriber or consumer to pay the tax to the company or seller, regardless of when the tax is collected by the department.
The statewide 988 behavioral health crisis response line account is created in the state treasury. All receipts from the statewide 988 behavioral health crisis response line tax imposed pursuant to this chapter must be deposited into the account. Moneys may only be spent after appropriation.
Expenditures from the account may only be used for (a) ensuring the efficient and effective routing of calls made to the 988 crisis hotline to an appropriate crisis hotline center or crisis call center hub; and (b) personnel and the provision of acute behavioral health, crisis outreach, stabilization services, and follow-up case management by directly responding to the 988 crisis hotline.
Moneys in the account may not be used to supplant general fund appropriations for behavioral health services or for medicaid covered services to individuals enrolled in the medicaid program.
If specific funding for the purposes of this act, referencing this act by bill or chapter number, is not provided by June 30, 2021, in the omnibus appropriations act, this act is null and void.