WSR 18-13-022
[Filed June 8, 2018, 11:18 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 16-14-040.
Title of Rule and Other Identifying Information: WAC 182-546-4600 Ambulance transportationInvoluntary substance use disorder treatmentRicky Garcia Act.
Hearing Location(s): On July 25, 2018, at 10:00 a.m., at the Health Care Authority (HCA), Cherry Street Plaza, Pear Conference Room #107, 626 8th Avenue, Olympia, WA 98504. Metered public parking is available street side around building. A map is available at or directions can be obtained by calling 360-725-1000.
Date of Intended Adoption: Not sooner than July 26, 2018.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email, fax 360-586-9727, by July 25, 2018.
Assistance for Persons with Disabilities: Contact Amber Lougheed, phone 360-725-1349, fax 360-586-9727, TTY 800-848-5429 or 711, email, by July 20, 2018.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: WAC 182-546-4600 allows for ambulance transportation for involuntary substance use disorder treatment.
Reasons Supporting Proposal: The agency is creating WAC 182-546-4600 to implement ESHB [E3SHB] 1713, also known as the Ricky Garcia Act.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160, ESHB [E3SHB] 1713, chapter 29, Laws of 2016 1st sp. sess.
Statute Being Implemented: RCW 41.05.021, 41.05.160, ESHB [E3SHB] 1713, chapter 29, Laws of 2016 1st sp. sess.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Amy Emerson, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1348; Implementation and Enforcement: Abigail Cole, P.O. Box 45510, Olympia, WA 98504-5510, 360-725-1835.
A school district fiscal impact statement is not required under RCW 28A.305.135.
A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The updates to WAC 182-546-4600 do not impose additional compliance costs or requirements on providers.
June 8, 2018
Wendy Barcus
Rules Coordinator
WAC 182-546-4600Ambulance transportationInvoluntary substance use disorder treatmentRicky Garcia Act.
(1) Definitions. For the purposes of this section, the following definitions and those found in chapter 182-500 WAC apply:
(a) "Behavioral health organization (BHO)" - See WAC 182-500-0015.
(b) "Chemical dependency professional" means a person certified as a chemical dependency professional by the department of health (DOH) under chapter 18.205 RCW.
(c) "Designated crisis responder (DCR)" means a mental health professional appointed by the behavioral health organization (BHO) to perform the duties described in RCW 70.96A.140.
(d) "Detention" or "detain" means the lawful confinement of a person, under chapter 71.05 RCW.
(e) "Gravely disabled" means a condition in which a person, as a result of a mental disorder, or as the result of the use of alcohol or other psychoactive chemicals:
(i) Is in danger of serious physical harm as a result of being unable to provide for personal health or safety; or
(ii) Shows repeated and escalating loss of cognitive control over personal actions and is not receiving care essential for personal health or safety.
(f) "Less restrictive alternative treatment" means a program of individualized treatment in a less restrictive setting than inpatient treatment and that includes the services described in RCW 71.05.585.
(g) "Nearest and most appropriate destination" means the nearest facility able and willing to accept the involuntarily detained person for treatment, not the closest facility based solely on driving distance.
(h) "Secure detoxification facility" means a facility operated by either a public or private agency that:
(i) Provides for intoxicated people:
(A) Evaluation and assessment by certified chemical dependency professionals;
(B) Acute or subacute detoxification services;
(C) Discharge assistance by certified chemical dependency professionals, including assistance with transitions to appropriate voluntary or involuntary inpatient services, or to less-restrictive alternatives appropriate for the client;
(ii) Includes security measures sufficient to protect the patients, staff, and community; and
(iii) Is certified as a secure withdrawal management and stabilization facility by the department of social and health services (DSHS) and the department of health (DOH).
(2) For a client involuntarily detained for substance use disorder (SUD) treatment, the agency covers transportation services under the ITA when the client has been assessed by a DCR and found to be one of the following:
(a) A danger to self;
(b) A danger to others;
(c) At substantial risk of inflicting physical harm upon the property of others; or
(d) Gravely disabled as a result of SUD.
(3) The agency pays for transportation under this section only when the transportation is:
(a) From one of the following locations:
(i) The site of the initial detention;
(ii) A local emergency room department;
(iii) A court hearing; or
(iv) A secure detoxification facility or crisis response center.
(b) To one of the following locations:
(i) A less restrictive alternative setting, except when ambulance transportation to a client's home is not covered;
(ii) A local emergency room department;
(iii) A court hearing; or
(iv) A secure detoxification facility or crisis response center.
(c) Provided by an ambulance transportation provider or law enforcement. The ambulance transportation provider must have an active core provider agreement (CPA) with the agency.
(d) To the nearest and most appropriate destination. The reason for a diversion to a more distant facility must be clearly documented in the client's file.
(4) The DCR authorizes the treatment destination based on the client's legal status.
(5) A copy of the agency's authorization of ambulance/secure transportation services under the Involuntary Treatment Act (ITA) form (HCA 42-003) must be completed and signed by the DCR and kept in the client's file.
(6) The SUD program, administered by DSHS, establishes payment for SUD-related transportation services when the transportation provider complies with DSHS requirements for drivers, driver training, vehicle and equipment standards and maintenance. Providers must clearly identify ITA transportation on the claim when billing the agency.