wa-law.org > bill > 2025-26 > HB 1809 > Original Bill
The legislature finds that:
The increased frequency of behavioral health emergencies in the community results in increased 911 calls to fire, emergency medical services, and law enforcement. First responders respond to behavioral health emergencies related to drug overdoses, acute suicidal behavior, acute crises, individuals requiring involuntary treatment, and other situations in which there are concerns about medical needs or safety;
In addition to fire, emergency medical services, and law enforcement responses to behavioral health calls, there are over 60 co-response teams currently operating across Washington to de-escalate situations, divert people from criminal justice and emergency medical systems, and bring medical and behavioral health care into the field to serve vulnerable populations;
There is a need for high acuity first response services for people experiencing behavioral health emergencies to complement the 988 crisis line and behavioral health crisis response system. To help address this need, 911 and 988 response systems must work together to create a seamless crisis care delivery system for individuals in crisis; and
First responders and co-response teams in the 911 system respond to behavioral health emergencies and other complex needs at the nexus of health and behavioral health. First responders and co-responders are critical to the provision of medical care in the field and ongoing case management and follow-up services, and they also fill gaps in behavioral health crises when there are no mobile crisis teams available.
The legislature intends to:
Provide high quality training and regional collaboration for co-response service delivery to achieve better care and deliver better outcomes for patients;
Equip emergency medical services personnel with the training they need to respond to behavioral health emergencies to save lives. With the proper training, first responders will be better prepared and more confident responding to behavioral health emergencies leading to reduced burnout among these professionals; and
Develop funding strategies for first responders to better respond to behavioral health emergencies and save taxpayer money. The funding model will incentivize first responders to connect neighbors in need to the right services which will reduce the dependence on emergency departments as the default drop-off location for persons experiencing a behavioral health crisis. By connecting persons in a behavioral health crisis with therapy, counseling, rehabilitative services, pharmacies, social workers, case workers, and shelters, instead of reimbursing ambulances for trips to the emergency department, communities will see a reduction in emergency department overcrowding.
By January 1, 2027, the department shall adopt rules related to the recognition of the behavioral health training in subsection (2) of this section as an optional module that may be incorporated into ongoing training and evaluation programs available to emergency medical technicians certified under this chapter.
By July 1, 2026, the behavioral health crisis outreach response and education center at the University of Washington shall develop a nine-hour training course to instruct emergency medical services personnel, including emergency medical technicians certified under this chapter and physician's trained advanced emergency medical technicians and paramedics certified under RCW 18.71.205, on responding to behavioral health emergencies. The training must be made available statewide in a format that allows for the course to be taught completely in-person, completely online, or a hybrid format of both in-person and online instruction. The training shall be developed in a manner to allow it to be provided through ongoing training and evaluation programs over the course of a three-year period.
Beginning July 1, 2027, the secretary shall issue a behavioral health endorsement to the certification of any emergency medical technician certified under this chapter who demonstrates to the secretary the successful completion of the training established under subsection (2) of this section.
By January 1, 2027, the behavioral health crisis outreach response and education center at the University of Washington, in consultation with the department, regional emergency medical services and trauma care councils established under RCW 70.168.100, and community and technical colleges, shall develop a course of instruction to train emergency medical technicians identified in subsection (1) of this section and physician's trained advanced emergency medical technicians and paramedics certified under RCW 18.71.205 who are seeking a behavioral health endorsement under either of those provisions. The course shall supplement the training in section 2 of this act and shall include advanced instruction in topics such as medical clearance for behavioral health patients, overdose, crisis de-escalation, and suicide prevention.
The department and the behavioral health crisis outreach response and education center at the University of Washington shall collaborate to encourage regional emergency medical services and trauma care councils established under RCW 70.168.100 and community and technical colleges to offer the course established in subsection (2) of this section regularly and statewide.
Obtaining a behavioral health endorsement under subsection (1) of this section or RCW 18.71.205 is voluntary and not a requirement for certification as an emergency medical technician or a physician's trained advanced emergency medical technician and paramedic.
The secretary of the department of health shall prescribe:
Practice parameters, training standards for, and levels of, physician's trained advanced emergency medical technicians and paramedics;
Minimum standards and performance requirements for the certification and recertification of physician's trained advanced emergency medical technicians and paramedics; and
Procedures for provisional certification, certification, recertification, and decertification of physician's trained advanced emergency medical technicians and paramedics.
Initial certification shall be for a period established by the secretary pursuant to RCW 43.70.250 and 43.70.280.
Recertification shall be granted upon proof of continuing satisfactory performance and education, and shall be for a period established by the secretary pursuant to RCW 43.70.250 and 43.70.280. By January 1, 2027, the department of health shall adopt rules related to the recognition of the behavioral health training in section 2(2) of this act as an optional module that may be incorporated into ongoing training and evaluation programs available to physician's trained advanced emergency medical technicians and paramedics.
As used in this chapter and chapter 18.73 RCW, "approved medical program director" means a person who:
Is licensed to practice medicine and surgery pursuant to this chapter or osteopathic medicine and surgery pursuant to chapter 18.57 RCW; and
Is qualified and knowledgeable in the administration and management of emergency care and services; and
Is so certified by the department of health for a county, group of counties, or cities with populations over four hundred thousand in coordination with the recommendations of the local medical community and local emergency medical services and trauma care council.
The uniform disciplinary act, chapter 18.130 RCW, governs uncertified practice, the issuance and denial of certificates, and the disciplining of certificate holders under this section. The secretary shall be the disciplining authority under this section. Disciplinary action shall be initiated against a person credentialed under this chapter in a manner consistent with the responsibilities and duties of the medical program director under whom such person is responsible.
Such activities of physician's trained advanced emergency medical technicians and paramedics shall be limited to actions taken under the express written or oral order of medical program directors and shall not be construed at any time to include freestanding or nondirected actions, for actions not presenting an emergency or life-threatening condition, except nonemergency activities performed pursuant to subsection (7) of this section.
Nothing in this section prohibits a physician's trained advanced emergency medical technician or paramedic, acting under the responsible supervision and direction of an approved medical program director, from participating in a community assistance referral and education services program established under RCW 35.21.930 if such participation does not exceed the participant's training and certification.
Beginning July 1, 2027, the secretary shall issue a behavioral health endorsement to the certification of any physician's trained advanced emergency medical technician and paramedic certified under this section who demonstrates to the secretary the successful completion of the training established under section 3(2) of this act.
The authority shall require reimbursement under medical assistance programs for fire departments and emergency medical services providing behavioral health services under this chapter through certified emergency medical technicians with a behavioral health endorsement issued under section 3 of this act or certified physician's trained advanced emergency medical technicians and paramedics with a behavioral health endorsement issued under RCW 18.71.205.
The authority, in collaboration with the behavioral health administrative services organizations and the behavioral health crisis outreach response and education center at the University of Washington, shall establish a pilot project in four behavioral health administrative services organizations. The pilot project must be designed to develop best practices for coordinating responses to behavioral health emergencies within the broader crisis response continuum and develop billing strategies for fire agencies, emergency medical service agencies, and law enforcement agencies that are not endorsed mobile rapid response crisis teams under RCW 71.24.903 that respond to behavioral health crisis situations. In addition, the pilot project shall be designed to assess the types of behavioral health training that are most relevant to first responders responding to behavioral health emergencies.
The pilot project shall be in effect between January 1, 2026, and June 30, 2027. The authority shall select four behavioral health administrative services organizations to be the pilot project sites. The authority shall select behavioral health administrative services organizations on both sides of the Cascade crest. The authority must select sites that either have integrated 911 and 988 response capacity or have plans to integrate 911 and 988 response capacity.
By July 1, 2027, the authority or its designee shall submit a report to the governor and the relevant committees of the legislature with a summary of the pilot project and its results, including best practices developed under subsection (1) of this section and recommendations for local, regional, and statewide implementation of the best practices.
The behavioral health administrative services organizations and the behavioral health crisis outreach response and education center at the University of Washington, in consultation with the authority, shall establish a program to administer a co-response education training academy resulting in a certification in best crisis response practices in three behavioral health administrative services organizations with a significant co-response footprint. The co-response education training academy shall be expanded to all 10 behavioral health administrative services organizations by 2027 and provide openings for other regional crisis and mobile response teams. The behavioral health administrative services organizations shall promote the training academy available to local co-response and crisis teams in their regions. The certification shall be optional and may not serve as an additional requirement for licensure for first responders or licensed human services professionals.
The behavioral health crisis outreach response and education center at the University of Washington may provide grants to small and rural co-response programs for staff to attend the training to offset increased costs associated with sending staff to training.
Subject to the availability of amounts appropriated for this specific purpose, the behavioral health crisis outreach response and education center at the University of Washington , in consultation and collaboration with the co-responder outreach alliance and other stakeholders as appropriate in the field of co-response, shall:
a.
Develop an assessment to be provided to the governor and legislature by June 30, 2026, and annually thereafter, describing and analyzing the following:
i. Existing capacity and shortfalls across the state in co-response teams and the co-response workforce and of emergency medical technicians and physician's trained advanced emergency medical technicians or paramedics operating with a behavioral health endorsement to their certification under section 3 of this act or RCW 18.71.205;
ii. Current alignment of co-response teams with cities, counties, behavioral health administrative services organizations, and call centers; distribution among law enforcement, fire, and EMS-based co-response models; and desired alignment;
iii. Current funding strategies for co-response teams and identification of promising funding opportunities;
iv. Current data systems utilized and an assessment of their effectiveness for use by co-responders, program planners, and policymakers;
v. Current training practices and identification of future state training practices;
vi. Alignment with designated crisis responder activities;
vii. Recommendations concerning best practices to prepare co-responders to achieve objectives and meet future state crisis system needs, including those of the 988 system;
viii. Recommendations to align co-responder activities with efforts to reform ways in which persons experiencing a behavioral health crisis interact with the criminal justice and emergency medical systems; and
ix. Assessment of training and educational needs for current and future co-responder workforce;
b. Host an annual statewide conference that draws state and national crisis responders from both 911 and 988 systems. The behavioral health crisis outreach response and education center at the University of Washington shall collaborate with stakeholders to increase the capacity of the annual conference to make it available to crisis responders across a variety of programs.