Legal Updates

2024 Washington state legislative updates

During the 2024 session, the Washington State Legislature reviewed many bills with implications for behavioral health service delivery. Dr. Allison Rooney summarized the following bills with CMHPL Director Dr. Jennifer Piel. Dr. Rooney is a UW Psychiatry Resident and a Resident-Fellow Representative to the Washington State Psychiatric Association. The following bills have been signed into law by the governor. Additional details on these and other bills considered by the state legislature are available on the legislature’s website. Although some laws remain contingent on funding, the effective date for most passed legislation is June 6, 2024.

SB 6308: An act relating to extending timelines for implementation of the 988 system

SB 6308 extends the timelines for implementation of certain components of the behavioral health crisis system. In July 2022, the National 988 Crisis Line was implemented in Washington with the goal to have development of a technology platform that could be used jointly between call centers and emergency response systems statewide by July 1, 2024. This legislation extends the deadline for development of the technology platform by the Department of Health by 18 months to January 1, 2026. Beginning January 2025, the Health Care Authority will facilitate and provide support for the Crisis Response Improvement Strategy Committee, which provides advice for creating the integrated behavioral health crisis response system.


HB 2088: An act relating extending liability protections for responders dispatched from mobile rapid response crisis teams and community-based crisis teams

HB 2088 provides legal protections for those providing crisis care services from mobile response teams and on-site community-based intervention services. It was previously established that specific designated staff of the 988 Contact Hub and Crisis Call Centers would have some legal protection related to their civic services for acts or omissions in good faith and within the scope of the individual’s employment responsibilities related to the 988 dispatching decisions and responsibilities. HB 2088 expands protections to other acute crisis responders when providing specified services or transportation. This includes certain staff of mobile rapid response crisis teams, 23-hour crisis reliefs centers, teams and facilities operated by tribes, and specific contracted behavioral health agencies among others. 


E2SSB 6251: Coordinating regional behavioral crisis response and suicide prevention services

E2SSB 6251 seeks to expand coordination of the regional crisis response system, specifically the 988 Contact Hubs and Regional Crisis Lines, in Washington. This bill was driven by reporting from the Crisis Response Improvement Strategy Committee that started in 2021 and calls for establishment of clear regional protocols for call centers, data-sharing agreements between the 988 contact hubs and regional crisis lines (including real-time information sharing), and the ability to revoke and re-designate a 988 call center contract if a facility fails to meet the state or national standards.

ESB 6246: Concerning transmission of information relating to firearm prohibitions for persons committed for mental health treatment

ESB 6246 amends former legislation regarding firearm possession prohibitions for individuals involuntarily committed or detained for mental health treatment. The law extends the persons required to surrender firearms to those whose non-felony criminal charges are dismissed based on incompetence to stand when the person has a history of one or more violent acts. For all applicable firearm surrenders, the law also outlines procedures and timelines for the court to issue an order prohibiting the person from possessing firearms until the court restores their right. This includes mandated reporting to the department of licensing, the Washington State Patrol background check program, the National Instant Criminal Background Check System, and the criminal division of the county prosecutor in the county of commitment or the county where charges were dismissed. The law clarifies that firearm rights shall not be restored if there exists a current extreme risk protection order or order to surrender weapons against the person petitioning for firearm restoration.


ESSB 5985: Concerning firearms background check program

ESSB 5985 updates existing statutes and protocols concerning background checks to specifically reference the Washington State Patrol (WSP) firearm background check program and requires a report of average time between receipt of requests for background checks and final decision to the Legislature. Also, for persons whose firearm rights are suspended for six months based on an initial mental health detention per RCW 71.05.050 or RCW 71.05.153, the firearm background check program must remove their names from the national instant criminal background check system (NICS) at expiration of the six-month period. This contrasts to the previous procedure which tasked the WSP to simply forward a notice to NICS. This will likely have the effect of a quicker turnaround for the liberties of gun restoration for these individuals.

Other legislation passed related to gun control includes HB 2118, SB 5444, and HB 1903. These bills pertain to additional requirements for the business operations of licensed firearm dealers, prohibiting firearms in certain protected spaces (libraries, zoos, aquariums, and transit facilities), and reporting lost or stolen firearms.

E2SHB 1618: An act relating to providing access to justice for survivors of childhood sexual abuse.

E2SHB 1618 eliminates the statute of limitations for recovery of damages as a result of childhood sexual abuse for all intentional actions occurring after June 6, 2024. Previously, the statute of limitations for claims of injuries suffered from damages as a result of childhood sexual abuse was three years from the time the victim discovered or should have reasonably discovered their injury was caused by the act. The policy aligns with 2019 legislation that removed the statute of limitations for criminal prosecution of childhood sexual abuse. 


SSB 5588: Concerning the Mental Health Sentencing Alternative

SSB 5588 amends prior legislation relating to the Mental Health Sentencing Alternative, established in 2021. The Mental Health Sentencing Alternative allows judges to divert from the standard range sentencing protocols if the defendant meets the following criteria (1) is convicted of a felony that is not a serious violent or sex offense; (2) is diagnosed with a serious mental health condition; (3) would benefit from supervision and treatment; and (4) the defendant themself is willing to participate in the sentencing alternative. This may involve in-patient or out-patient mental health care as well as a period of community custody where the individual is monitored by a trained community correction officer. The amendments to this legislation allow a correctional facility to delay a defendant’s release from total confinement, if doing so promotes adherence to the treatment plan. For instance, delays are allowed to coordinate transfers to in-patient treatment facilities, ensure transport is available, or release the defendant on a weekday when out-patient services are available. The amendments also include clauses for providing reimbursement for facilities participating in these sentencing alternatives.


E2SSB 5937:  Supporting crime victims and witnesses by promoting victim-centered, trauma-informed responses

E2SSB 5937 seeks to expand support for crime victims and witnesses by promoting victim-centered, trauma-informed responses in the legal system. Included within this bill are stricter guidelines for when a victim’s past sexual behavior may be permissible in court, as well as increased reimbursement for expenses related to medical examinations and interviews. The law specifically includes language that crime victims’ rights apply to adult and juvenile criminal court proceedings, but also civil commitment proceedings for insanity and sexually violent predators. Additionally, this legislation removes the statute of limitations for charges of rape committed by first responders who use their position to facilitate the offense. This change takes effect July 1, 2024. 


SB 5825: Concerning guardianship and conservatorship

SB 5825 updates the law on granting public guardianship. In 2022 Washington put into place the Uniform Guardianship, Conservatorship, and Other Protective Arrangements Act (UGA), which promoted more strict criteria for who and how guardianship is granted. SB 5825 expands who can be granted public guardianship. This is updated to include individuals who are currently receiving care in a hospital setting (including psychiatric facilities) who are ready to be discharged and in need of urgent guardianship but do not have another qualified person who is willing to serve as a guardian. Parameters include individuals age 18 or older with an income that does not exceed 400 percent of the federal poverty level. The Office of Public Guardianship (OPG) is tasked with creating a streamlined process to review and assign decision makers for these specified individuals, and, starting in 2025, the OPG shall provide an annual report on the demand for these services, barriers to delivery, and outcomes achieved. 


SSB 6227:  Allowing entry of a civil protection order to protect victims when a person is found not guilty by reason of insanity

SSB 6227 amends former legislation to allow a court to enter a separate no-contact order in cases where the defendant is found not guilty by reason of insanity and committed by the court to inpatient treatment or conditional release. This is pertinent in instances where the person acquitted by reason of insanity is conditionally released after being deemed not a substantial danger to other persons or public safety but remains under control of the court. With this, a court may enter a separate no-contact order to protect any victim of the person’s conduct as well as an order of commitment for the person during the entire time while the person remains under control of the court. The maximum term of the no-contact order will be the same as the maximum term of commitment or until the person’s release. A violation of this no-contact order will result in a criminal offense and possible felony.


SB 6079: Making juvenile detention records available to managed health care systems

SB 6079 has multiple components related to the release of juvenile detention records. Specifically, this law directs that the records of an individual detained in a juvenile detention facility be made available to managed care organizations and behavioral health administrative services for the purposes of care coordination. This legislation appears to be in response to an approved waiver in 2023 where the Centers for Medicare and Medicaid Services approved the Health Care Administration’s waiver request that would allow coverage for pre-release services up to 90 days prior to an individual’s expected date of release from confinement (previously 30 days following legislation in 2021). The law seeks to decrease gaps in care on release from incarceration.

2SSB 6228 Concerning treatment of substance use disorders 

2SSB 6228 contains a multitude of provisions that seek to encourage substance use treatment in the state. Among the provisions, the legislation attempts to limit Medicaid and Managed Care Organizations (MCOs) from declining coverage of recovery programs by placing parameters around medical necessity standards. Some of these include establishing minimum guaranteed covered treatment periods (14 days for initial treatment, 7 days for subsequent treatment); preventing health plans and MCOs from using a period of abstinence as the primary factor in denying medical necessity criteria; and not allowing a period of abstinence to be considered in medical necessity criteria at all if it occurred due to incarceration, inpatient treatment, or hospitalization. The legislation caps certification fees in efforts to grow the behavioral health workforce. It requires several reporting procedures and investigational studies. 

Further, it directs Behavioral Health Agencies (BHAs) treating patients for an alcohol or opioid use disorder to provide patients with education related to pharmacological treatment options, and requires the BHA to either provide the medication or conduct a warm handoff referral if the patient chooses a medication. It also seeks to enhance care by preventing “withdrawal management providers” from categorically requiring patients to discontinue all psychotropic medications before treatment and there must be a good-faith effort to consult a patient’s provider for individualized plans. 


HB 2396: Concerning fentanyl and other synthetic opioids

HB 2396, which will be known and cited as “Ivan’s Law,” has three major components relating to opioid use disorders. First, it tasks the Department of Health and the Washington Poison Center to provide resources on decontaminating motor vehicles of fentanyl residue to law enforcement agencies. Second, it creates guidelines for public outreach campaigns. These guidelines include developing and disseminating material that is culturally appropriate, accessible in other languages, accessible to the deaf and blind communities, and includes the use of the phrase “Not Even Once” where appropriate. Third, it establishes a requirement that resources on fentanyl and opioid use disorder treatment programs must be provided to individuals when released from jail custody.


E2SHB 1956: Addressing fentanyl and other substance use prevention education

E2SHB 1956, which will be known as the “Lucas Petty Act” is in coordination with SB 5906, and directs the Department of Health (DOH) to develop, implement, and maintain a statewide drug overdose prevention and awareness campaign that has an increased focus on synthetic opioids and the high possibility of contaminates. Among provisions, it specifies requirements for public schools and the state health learning standards to include classroom materials on the lethality of fentanyl and other opioids. It dictates that, by December 1, 2025, the Office of the Superintendent of Public Instruction must adjust the state health and physical education learning standards for middle and high school students to add opioids to the list of drugs included in mandatory teaching and learning standards. This went into effect March 19, 2024. 


SSB 5804: Concerning opioid overdose reversal medication in high schools

SSB 5804 updates existing legislation requiring all schools to maintain opioid overdose reversal medication. The prior legislation required only school districts with 2000 or more students to maintain reversal medication at each high school in the district. The new legislation requires all school districts, charter schools, and state-tribal education compact schools to obtain and maintain at least one set of opioid overdose reversal medication doses in each of the public schools (not just high schools). The legislation also encourages public schools to include the location of the reversal medication on an emergency map and to include opioid overdose reversal medication in each first aid kit maintained on school property and in any coach or sports first aid kits.


2SHB 2112: Concerning opioid and fentanyl prevention education and awareness at institutions of higher education

2SHB 2112 includes three main provisions for institutions of higher education related to substance use prevention and treatment, contingent on funding. First, it directs each public and private institution of higher education to provide opioid and fentanyl prevention education and awareness to students, including information about Washington’s Good Samaritan Law. Second, it requires that Naloxone and fentanyl strips be made available to students on campus in various accessible locations such as student wellness centers, union buildings, and housing facilities. Third, the institutions must provide training to the staff working in residence halls on administering naloxone. 

Background: There are 29 federally recognized Indian tribes in Washington. Health care on tribal lands is provided through an Indian health care delivery system that is supported by the federal Indian Health Service providing care in urban and rural areas. Behavioral health services are provided by Indian health care providers and Urban Indian Health Programs, and include outpatient mental health, outpatient substance use disorder, and inpatient substance use disorder programs.


SHB 2075: Concerning licensing of Indian health care providers as establishments

SHB 2075 allows an Indian health provider to be licensed as an establishment by the Department of Health (DOH) if the facility attests that it meets the minimum state standards and pays their administrative fee. Licensing standards are for facilities that care for persons with mental illness or substance use disorders and could include residential treatment facilities or psychiatric hospitals. The DOH must license an Indian health care provider as an establishment if it submits a tribal attestation as to having met the state minimum standards and pays an administrative processing fee, starting July 1, 2025.


2SHB 1877: An Act Relating to Improving the Washington state behavioral health system for better coordination and recognition with the Indian behavioral health system

2SHB 1877 includes various measures aiming to improve the coordination with and recognition of the Indian behavioral health system. Many of the measures relate to the Involuntary Treatment Act (ITA) and include allowing tribal prosecuting attorneys to access closed court records under the ITA; requiring the health care authority (HCA) to reimburse tribes for their court costs related to the ITA; allowing attorneys representing a tribe to intervene in ITA hearings involving tribal members; and enhancing notification to tribes and providers when American Indians and Alaskan natives interact with the involuntary treatment system. Additionally, this legislation requires the HCA to establish written guidelines for culturally competent involuntary treatment evaluations. A person summoned to an outpatient involuntary commitment evaluation may be accompanied by a traditional cultural healer.  The Administrative Office of Courts must update court forms related to the Involuntary Treatment Act by December 1, 2024.  The HCA must establish written guidelines by December 31, 2024, for conducting culturally appropriate involuntary treatment evaluations for American Indians and Alaska Natives, in consultation with Indian health care providers and the American Indian Health Commission.


SSB 6099: Creating the Tribal Opioid Prevention and Treatment Account

SSB 6099 establishes a Tribal Opioid Prevention and Treatment Account (TOPTA) under the state treasurer to be used to address the opioid epidemic in tribal communities. This includes funding to be provided for prevention and recovery services, treatment programs, peer services, awareness campaigns, and support for first-responders. The funding for this account comes from the Opioid Abatement Settlement which is a settlement the state of Washington made with several companies that should total about $480 million paid out over 6 to 17 years. Beginning July 1, 2025, and annually thereafter, the TOPTA will receive $7.75 million or 20 percent of receipts from the prior fiscal year of the Opioid Abatement Settlement. This legislation takes effect on July 1, 2024.

SB 5853: Extending crisis relief center model to provide behavioral crisis centers for minors

Senate Bill 5853 is an expansion of SB 5120 from last year’s legislative cycle that directed the Department of Health (DOH) to certify or license 23 hour-crisis relief centers (CRCs) to provide behavioral health care to adults in crisis. SB 5853 expands this measure and requires CRCs to meet the needs of children over the age of eight and their families. The bill includes requirements on a pediatric multidisciplinary team, written policies on how different age children will be separated, and discharge planning for vulnerable youth. The DOH expects to finalize rulemaking for CRCs and start accepting license applications in May 2024. By March 31, 2025, DOH must create licensure and certification rules for CRCs which provide services to children in consultation with the Health Care Authority and the Department of Children, Youth, and Families. 


2SHB 1929: Supporting young adults following inpatient behavioral health treatment

2SHB 1929 establishes the Post-Inpatient Housing Program for Young Adults within the Health Care Authority (HCA). The program is designed to provide transitional housing and behavioral health support for youth (ages 18-24) following discharge from the hospital with a focus on securing long-term housing. The legislation directs the HCA to designate one community-based organization, tribe, or tribal institution to establish two residential programs (on different sides of the state) with 6-10 beds to serve young adults for stays up to 90 days. The residential facilities must be voluntary and not a secure facility that restricts the individual’s rights to come and go. The facilities must provide behavioral health support for program participants including on-site and community-based behavioral health support, peer support, and medication management.


ESHB 2256: Addressing the children and youth behavioral health work group

ESHB 2256 amends prior legislation to change the requirements for the work group addressing behavioral health services for children. The amendments include expansion of the goals, specifiers for work group membership and leadership, extension of the deadline for a behavioral health strategic plan, and continuation of the work group to December 30, 2029. There are currently 38 members of the work group, including legislators, representatives from state agencies, providers, parent and child representatives, and advocates. The work group members will now include three youth or young adult representatives who have experience with behavioral health issues, allow the governor to appoint additional representatives from state agencies, and specify that the non-legislative co-chair is a representative from the Health Care Authority.


E2SSB 5908: Providing Extended Foster Care services to youth ages 18 to 21

E2SSB 5908 modifies the existing legislation related to Extended Foster Care (EFC) to promote awareness, increase eligibility, and allow an independent living subsidy for certain youth. In 2011, the Department of Children, Youth and Families (DCYF) started this extended foster care system for individuals ages 18 to 21 who elected to participate in the program. The program remains entirely optional for youth, but seeks to expand the accessibility of the program for those who opt in. The legislation has gone through several modifications over the years to promote accessibility and coverage. The current modifications primarily relate to the supervised independent living subsidy, indicating that a youth may elect to live independently or receive a licensed foster care placement. The new amendments also direct the DCYF to increase awareness by developing policies to inform dependent youth starting at age 15 about the EFC program. The legislation also increases the timespan youth can register for EFC to six months prior to their 18th birthday and any time after their 18th birthday until age 21. Finally, the new amendments direct the DCYF to provide age appropriate social work support for the youth in EFC that includes contact with those with lived experience with the foster care system. 

SSB 5660: Establishing a Mental Health Advance Directive Effective Implementation Work Group

Senate Bill 5660 directs the Health Care Authority (HCA) to create a Mental Health Advance Directive Effective Implementation Work Group in an effort to develop better recommendations on effective implementation of Mental Health Advanced Directives (MHAD) in the community. As part of the work group there are two designated subgroups, the first responsible for document storage and recommendations regarding how to implement a statewide MHAD repository. The second subgroup is responsible for the training of document creation and utilization, including developing training toolkits. The bill sets guidelines for the work group’s membership which will include members from the Washington State Psychiatric Association, Washington State Medical Association, Designated Crisis Responders, Emergency Service Responders, and many more. The work group must provide a report to the governor and relevant committees of the legislature by December 1, 2025.


SSB 5920: Lifting need requirements for psychiatric hospitals and beds

SSB 5920 reinstates the ability of the Department of Health (DOH) to grant Certificate of Need exemptions to increase the number of psychiatric beds in the state. For background on this legislation, a Certificate of Need is typically required by a healthcare facility planning to construct, sell, purchase, lease, renovate, or alter a facility in any way. In 2014, the legislature suspended the requirement for increasing psychiatric beds within a hospital. It has since been renewed several times by the legislature but expired on June 30, 2023. This bill reinstates the ability of the DOH to issue exemptions until June 20, 2028 for (1) adding new psychiatric beds to a hospital; (2) changing the use of beds within a hospital to increase the number of psychiatric beds; or (3) constructing, developing, or establishing a new psychiatric hospital. The legislation takes effect 90 days after the adjournment of session.



California Supreme Court case regarding electroconvulsive therapy

The California Supreme Court will be hearing oral arguments on April 3 at 9:00 a.m. PT in Himes v. Somatics, an important case concerning concerning electroconvulsive therapy (ECT).

Learn more about the case here:

American Psychiatric Association Amicus Cites Safety, Effectiveness of ECT in California Supreme Court Case


Confidentiality of substance use disorder patient records

In February 2024, the Department of Health and Human Services issued its Final Rule on new provisions for integrated care and confidentiality for patients with substance use conditions to align 42 CFR Part 2, addressing the confidentiality of substance use treatment records, with the confidentiality requirements of HIPAA. Please see the Final Rule and Fact Sheet for details.


Independent medical exams in L&I claims

Legislation passed in Washington state during the 2022–2023 session made changes to the independent medical exam (IME) process, including recording of mental health exams. The Washington State Department of Labor & Industries is in the process of rulemaking around recording of IMEs. A public hearing is scheduled for February 6, 2024.


US Supreme Court to decide case of expert admissibility

The U.S. Supreme Court heard oral arguments on January 10, 2024 in the case of Smith v. Arizona.  It will be of interest to forensic experts because it involves a challenge to the admissibility of drug-analysis testimony when the testifying expert relied on data generated by a non-testifying expert.  The case has implications for a wide-range of forensic experts.

The question before the Court: Does the Confrontation Clause of the Sixth Amendment permit the prosecution in a criminal trial to present testimony by a substitute expert conveying the testimonial statements of a non-testifying forensic analyst?

For more information:  Smith v. Arizona | Oyez


Changes to Federal Rule of Evidence 702

An amended Rule 702 for testimony by expert witnesses went into effect on December 1, 2023.

The new rule, as amended, states: A witness who is qualified as an expert by knowledge, skill, experience, training or education may testify in the form of an opinion or otherwise if the proponent demonstrates to the court that it is more likely than not that:

  1. the expert’s scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue;
  2. the testimony is based on sufficient facts or data;
  3. the testimony is the product of reliable principles and methods; and
  4. the expert’s opinion reflects a reliable application of the principles and methods to the facts of the case.

This reinforces the court as the “gatekeeper” and that the proponent of the expert testimony is tasked with establishing that the reliability requirements are met to a “more likely than not’ standard. This language also calls on the court to consider the conclusion the expert has drawn from their methodology.

Second Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications

The U.S. Drug Enforcement Agency, together with the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a Second Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications. Key provisions include:

  • The telemedicine flexibilities for prescriptions of controlled substances put into place during the Public Health Emergency (PHE) will remain in effect through December 31, 2024.
  • These telemedicine flexibilities authorize practitioners to prescribe schedule II-IV controlled medications via audio-video telemedicine encounters, including III-V narcotic controlled medications approved by FDA for treatment of opioid use disorder via audio-only telemedicine encounters.
  • This includes any practitioner-patient telemedicine relationships that have been or will be established up to December 31, 2024.
  • New standards are expected by fall 2024.

Additional resource:  DEA Extends Telehealth Flexibilities Another Year


2023 Washington State Legislative Updates

During the 2023 session, the Washington State legislature reviewed many bills with implications for behavioral health. Undergraduate Sarah Forslund, with CMHPL Director Dr. Jennifer Piel, summarized several new laws that were passed this session. Additional details on these and other bills considered by the state legislature are available on the legislature’s website. The effective date for most passed legislation is July 23, 2023.

2SSB 5120 Establishing 23-hour crisis relief centers in Washington state

Senate Bill 5120 directs the Department of Health to certify or license 23-hour crisis relief centers to provide behavioral health care to adults in crisis. Crisis relief centers are expected to accept walk-in patients, people brought in by first responders, and people referred through the 988 system regardless of their behavioral health acuity. The goal is to provide increased access to care for persons experiencing a behavioral health condition.


E2SHB 1134 Implementing the 988 behavioral health crisis response and suicide prevention system

House Bill 1134 includes measures to enhance promotion and services related to implementation of the 988 behavioral health crisis response and suicide prevention system, in an effort to streamline clinical interventions and access to resources for people experiencing a behavioral health crisis. Among provisions identified in the bill are requirements for call centers related to training, development and promotion of informational materials for different demographics, and liability protections for crisis workers. Implementation of the 988 has facilitated care for persons experiencing behavioral health crises. This law will provide additional measures to enhance existing services.

SB 5228 Providing occupational therapy services for persons with behavioral health disorders

Senate Bill 5228 provides that behavioral health administrative service organizations and managed care organizations may use their funding to deliver occupational therapy services to individuals receiving treatment for a behavioral health disorder with one of those organizations.


SSB 5300 Concerning continuity of coverage for prescription drugs prescribed for the treatment of behavioral health conditions

This law prohibits a health carrier from substituting a non-preferred drug with a preferred drug within a plan year, if the prescription is for the treatment of an enrollee’s serious mental illness, the enrollee is medically stable, and the provider continues to prescribe the drug. The goal is to maintain patients on their antipsychotic, antidepressant, antiepileptic medication, or other prescribed medication that has been effective to treat a serious mental illness.

E2SHB 1715: Enacting comprehensive protections for victims of domestic violence and other violence involving family members or intimate partners

House Bill 1715 was introduced with goal of bolstering protections for victims of domestic violence with changes to civil proceedings, domestic violence protections, and regulations around firearms and dangerous weapons. Some of these amendments include training for law enforcement and judicial officers to use trauma-informed techniques at various stages of their interactions with victims of domestic violence. The law establishes a pilot program for domestic violence high risk teams. The law also appropriates funds for the University of Washington (UW), with external stakeholder input, to establish a Center of Excellence in Research, Policy, and Practice to Reduce Domestic Violence. The UW School of Public Health is leading the planning with assistance from faculty and others across schools at the university.


HB 1696 Concerning stalking-related offenses

The bill modifies the scope of conduct that constitutes the crime of Stalking. Among changes, the crime includes inflicting “substantial emotional distress” to a victim of stalking or placing the victim in fear of injury. The victim’s fear of injury was an element of the prior crime of Stalking. The definition of victims’ “substantial emotional distress” includes reactions such as anxiety, apprehension, or loss of ability to concentrate or other symptoms which negatively impact their quality of life. The law also incorporated cyberstalking. A person who experiences a stalking-related offense may develop anxiety or other behavioral health condition, which may require medical or other professional treatment.


2SHB 1028 Supporting crime victims and witnesses by promoting victim-centered, trauma-informed responses in the legal system

House Bill 1028 created a Sexual Assault Forensic Examination Best Practices Advisory Group and steps to better address victims and witnesses of gender-based violence crimes. Support within the legal system includes training individuals to interact with victims of gender-based violence that appropriately addresses the victim’s trauma. The law includes provisions for trauma-informed training of peace officers, disclosure authorizations, evidentiary procedures for use of a victim’s social medial account to demonstrate consent, and procedures for collection of biological samples in certain settings. Behavioral health clinicians and victims’ rights advocates have pushed for increasing training and implementing trauma-informed services for these people.


ESHB 1394 Creating a developmentally appropriate response to youth who commit sexual offenses

House Bill 1394 decreases the period of time a juvenile is required to remain on the juvenile sex registry and, in some cases, extinguishes the requirement to register at all. This law also tasks the Department of Children, Youth, and Families to develop and implement a grant program for attorneys to apply for funding for sex offender evaluation and treatment programs. The definition of “certified affiliate sex offender treatment provider” is also expanded under this law to include clinicians with specific associate licenses.

SSB 5006: Clarifying waiver of firearm rights

Senate Bill 5006 amends the previous law regarding unlawful firearm possession to include further clarification on the waiver of firearm rights. If a person obtains a firearm after a voluntary waiver of firearm rights has been filed and accepted while the waiver is still in effect, that is considered an infraction. Additionally, when filing a waiver, an individual may provide the name of someone (including a behavioral health clinician) to be notified in case they attempt to purchase a firearm or apply to have the waiver revoked. Although it encourages behavioral health clinicians to discuss voluntary waiver of firearm rights with patients, the law does not obligate clinicians named by a person filing a waiver to take any specific actions, thereby limiting liability concerns.


SHB 1240: Establishing firearms-related safety measures to increase public safety

House Bill 1240 prohibits the manufacture, importation, distribution, sale, or offer for sale of any assault weapons in Washington State, with few exceptions. Although there is already a federal lawsuit challenging its constitutionality, the impetus of the law was to reduce incidences of gun violence, including suicide.


SHB 1562: Reducing the risks of lethality and other harm associated with gun violence, gender-based violence, and other types of violence

House Bill 1562 amends the crime of Unlawful Possession of a Firearm to include a revised definition of “firearm”, and adds definitions for “domestic violence”, and “sex offense.” The law revises the eligibility for firearm rights following criminal convictions and expands the crimes that prohibit individuals from possessing firearms. It also amends provisions for persons found not guilty by reason of insanity.

E2SSB 5440 Providing timely competency evaluations and restoration services to persons suffering from behavioral health disorders

This bill includes a number of different provisions related to competence to stand trial, several of which are mentioned here. The law introduces “clinical intervention specialists” as a licensed professionals with prescribing authority who will provide direct clinical services and consultation to jails for persons waiting for competency to stand trial services. The law requires judges to determine if there is a genuine doubt as to the defendant’s trial competency before ordering a competency evaluation by a forensic evaluator. Among other provisions, the court may order revocation of a person’s driver’s license for one year for persons charged with a serious traffic offense and found to be incompetent to stand trial; the law includes provisions for reinstatement of the license. For non-felony crimes, the court shall consider appropriate alternatives to inpatient competency restoration, including diversion programs. Additional duties for forensic navigators now include assessing defendants for appropriateness for assisted outpatient treatment and providing updates on the status of individuals’ participation in diversion or outpatient services. DSHS is tasked with developing a process to connect persons found not competent to stand trial due to intellectual disability, developmental disability, dementia, or traumatic brain injury to community-based services.


2SSB 5134 Concerning reentry services and supports

Senate Bill 5134 concerns community reentry for incarcerated persons. It outlines the minimum sum of money to be provided to detainees upon release from confinement from a state correctional facility. With this bill, the legislature passed revisions that would have expanded the Department of Corrections required discharge planning services by adding a number of case management linkage services. The Governor partially vetoed the bill that passed the legislature due to inadequate funding and capacity to absorb the work within the Department of Corrections, including the case management services. The Governor did direct the Department of Corrections to provide 90-day supplies of necessary prescribed medications upon release, as clinically appropriate.


SS 5087 Removing language from the Revised Code of Washington that has been identified by the justices of the supreme court or judges of the superior courts as defects and omissions in the laws pursuant to Article IV, section 25 of the Washington state Constitution

Although the Washington Supreme Court struck down the state’s death penalty as unconstitutional under state law in 2018, the state legislature had not abolished the death penalty. This law abolishes the death penalty in Washington, as well as removes several prior laws that the state supreme court determined to be invalid or unconstitutional. Among states with the death penalty, some have recently considered limitations for persons with serious mental illness. It is unconstitutional to punish someone by death who was a juvenile at the time of the criminal offense, is intellectually disabled, or incompetent to be executed. Washington is the 23rd state to abolish the death penalty.


SHB 1068 Concerning injured workers’ rights during compelled medical examinations

House Bill 1068 authorizes employees to audio and video record compelled independent medical examinations in workers’ compensation cases, including during psychiatric examinations. Prior law precluded recording of psychiatric examinations in Labor and Industries evaluations. The worker must not alter the recording, and the worker must provide a copy of the recording to the Department of Labor and Industries. The law details that reasonable steps must be taken to ensure the recording does not interfere with the examination.

2SSB 5502: Ensuring access to substance use disorder treatment

Bill 5502 requires offenders to undergo assessment and, if deemed necessary, treated for substance use disorder in order to transfer to a graduated reentry program. The graduated reentry program allows the Department of Corrections to transfer individuals, after serving specified times of confinement, to an approved address with monitoring when certain eligibility requirements are met. With this, Department of Corrections will be responsible for assisting incarcerated persons in enrolling in appropriate substance use treatment.


2SHB 1168: Providing prevention services, diagnoses, treatment, and support for prenatal substance exposure

House Bill 1168 outlines the steps for Health Care Authority (HCA) to enhance services for children and families that are involved (or at risk of involvement) in the child welfare system with prenatal exposure to substances. The HCA must contract with providers with expertise in comprehensive prenatal exposure treatment and trauma-informed services.

The HCA must support these providers through education, training, and coaching. Outcome data will be collected to further inform ways to increase access to diagnoses, treatment, services, and support for children who were exposed to substances before birth and their families. Behavioral health clinicians may be involved in treatment and providing education for families and children who experience prenatal substance exposure.


SB 1255: Reducing stigma and incentivizing health care professionals to participate in a substance use disorder monitoring and treatment program

The Nursing Care Quality Assurance Commission is the disciplinary authority for nurses in Washington and may refer license holders to Washington Health Professional Services (WHPS) for voluntary substance use treatment and monitoring, when applicable, as an alternative or in conjunction with disciplinary actions. In effort to encourage participation in substance use treatment and monitoring, this law clarifies and limits public disclosure of enforcement actions taken against a nurse participating in such a program. The law also requires the Nursing Commission to establish a stipend program to assist license holder participation in WHPS with related out-of-pocket expenses. This law aims to reduce stigma around getting treatment for substance abuse disorders.

 SSB 5189: Establishing behavioral health support specialists

Senate Bill 5189 requires the Department of Health in collaboration with the University of Washington Department of Psychiatry, to establish rules for certification of Behavioral Heath Support Specialists (BHSS). A BHSS is a new type of behavioral health professional who will deliver brief behavioral interventions under the supervision of a credentialed provider with the ability to assess, diagnose, and treat behavioral health conditions. A BHSS will not be certified to make diagnoses but can track and monitor treatment response using measurement-based care. The University, with other stakeholders, developed a training curriculum and guidelines for BHSS. With this law, the Health Care Authority must also take necessary steps to ensure Medicaid coverage of BHSS services. The goal is to improve access to evidence-based interventions for persons with mental health conditions.


SHB 1069 Adopting the mental health counselor compact

House Bill 1069 enacts the Mental Health Counselor Compact in Washington State. The Compact is an agreement among states which allows a licensed professional counselor residing in their home state to practice in a remote state. Both the home state and remote state must be members of the Compact, and a counselor must reside and be licensed in their home state to practice in another member state. As of January 1, 2023, the Compact had 17 member states. With ease of interstate practice, the goal is to increase public access to professional counseling.

ESSB 5179: Increasing access to the provisions of the Washington death with dignity act

The Death with Dignity Act was established in 2008 in Washington State. Under this Act, an individual with a terminal illness with six months or less to live may request medication to self-administer to end their life when additional requirements are met, including the decision is made competently and voluntarily. Under prior law, if either the attending physician or consulting physician determined that the patient may have a psychiatric condition that impairs the patient’s judgment, the patient is referred for counseling with a psychiatrist or psychologist. Among other things, this law expands the types of providers who may provide counseling under the Act, including independent social workers, mental health counselors, and psychiatric advanced registered nurse practitioners.


New DEA training requirement: Effective June 27, 2023

In March 2023, the U.S. Drug Enforcement Agency (DEA) released details of a new training requirement for DEA-registered practitioners. The Medication Access and Training Expansion Act created a mandatory one-time, eight-hour training requirement for DEA registrants “on the treatment and management of patients with opioid or other substance use disorders.”

As of June 27, 2023, clinicians will be prompted to affirm completion of the new training requirement on their next scheduled DEA registration submission — whether an initial application or renewal. This is a one-time requirement and does not have to be repeated for subsequent license renewals.

Some clinicians will be exempt from the eight-hour training requirements, including those who are board-certified in addiction medicine or addiction psychiatry via the American Board of Medical Specialties, the American Board of Addiction Medicine, or the American Osteopathic Association. There are also some exemptions for recent graduates of medical, physician assistant, or advanced practice nursing schools who completed a comprehensive curriculum that satisfies the training requirement.

A number of organizations are providing training that can be used to fulfill the new DEA training requirement. Previous training completed as part of obtaining an X waiver may also be counted toward the requirement. The American Medical Association has resources and training links to help clinicians meet the requirement.