WSR 25-16-075

PROPOSED RULES

DEPARTMENT OF HEALTH

[Filed August 1, 2025, 2:56 p.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 24-13-112.

Title of Rule and Other Identifying Information: Licensing and certification standards for 23-hour crisis relief centers (CRC) serving minors in Washington state. The department of health (department) is proposing amendments to WAC 246-341-0903 to implement E2SSB 5853 (chapter 367, Laws of 2024), codified in RCW 71.24.916, extending the CRC model to provide behavioral health crisis relief services to minors.

Hearing Location(s): On September 16, 2025, at 1:00 p.m., via Zoom. Register in advance for this webinar at https://us02web.zoom.us/webinar/register/WN_rnCq4F38ST6IBhsM5eA45g. After registering, you will receive a confirmation email containing information about joining the webinar.

Date of Intended Adoption: September 18, 2025.

Submit Written Comments to: Dan Overton, P.O. Box 47843, Olympia, WA 98504-7843, email dan.overton@doh.wa.gov,https://fortress.wa.gov/doh/policyreview/, beginning the date and time of this filing, by September 16, 2025, 11:59 p.m.

Assistance for Persons with Disabilities: Contact Dan Overton, phone 564-201-0579, TTY 711, email dan.overton@doh.wa.gov, by September 2, 2025.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: In 2023, the legislature passed 2SSB 5120 (chapter 433, Laws of 2023), establishing 23-hour CRCs, a new type of behavioral health service model providing mental health and substance use crisis response. In definition, CRCs were limited to serving adults. In 2024, the legislature passed E2SSB 5853 extending the CRC model to provide behavioral health crisis relief services to minors.

The department is proposing amendments to WAC 246-341-0903 to create licensure and certification standards for 23-hour CRCs who intend to provide behavioral health crisis relief services to minors eight years of age and older. The proposed amendments will align with the statutory changes made in E2SSB 5853. In addition to the statutory requirements, the proposed amendments include training standards for staff who treat minors; standards for consent to treat minors; policies on admission, treatment, discharge of minors; a memorandum of understanding with the department of children, youth, and families (DCYF) regarding collaboration to serve minors and their families; and protocols for allowing a minor to stay beyond 23 hours and 59 minutes. Finally, the proposed amendments update terminology in the context of healthcare and add the following definitions of terms used in this section: Abuse or neglect; admission, admitting, and admit; adolescent; dependent child; minor; and parent.

Reasons Supporting Proposal: In 2024, the legislature passed E2SSB 5853, extending the CRC model to provide behavioral health relief services to minors age eight and older. Section 2 of E2SSB 5853 directs the department to amend the licensure and certification rules for 23-hour CRCs that intend to provide crisis relief services to minors. The department has worked in consultation with the health care authority (HCA) and DCYF, and conducted workshops seeking input from interested parties in order to develop licensing and certification standards that meet the intent of E2SSB 5853. The proposed amendments will align with the statutory changes and protect the minors who are seeking crisis relief services.

Statutory Authority for Adoption: RCW 71.24.037 and E2SSB 5853 (chapter 367, Laws of 2024), codified in RCW 71.24.916.

Statute Being Implemented: RCW 71.24.037 and 71.24.916.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Department of health, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Dan Overton, 111 Israel Road S.E., Tumwater, WA 98501, 564-201-0579.

A school district fiscal impact statement is not required under RCW 28A.305.135.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Dan Overton, P.O. Box 47843, Olympia, WA 98504-7843, phone 564-201-0579, TTY 711, email dan.overton@doh.wa.gov.

This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:

Is exempt under RCW 19.85.025(3) as the rules are adopting or incorporating by reference without material change federal statutes or regulations, Washington state statutes, rules of other Washington state agencies, shoreline master programs other than those programs governing shorelines of statewide significance, or, as referenced by Washington state law, national consensus codes that generally establish industry standards, if the material adopted or incorporated regulates the same subject matter and conduct as the adopting or incorporating rule; rules only correct typographical errors, make address or name changes, or clarify language of a rule without changing its effect; and rule content is explicitly and specifically dictated by statute.

Explanation of exemptions: Portions of the proposed amendments are exempt because they incorporate the amended statute. Portions of the proposed amendments also clarify the language in statute. Explanations of exemptions are identified below.

Scope of exemption for rule proposal:

Is partially exempt:

Explanation of partial exemptions: [See below].

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.

A brief description of the proposed rule, including the current situation/rule, followed by the history of the issue and why the proposed rule is needed. A description of the probable compliance requirements and the kinds of professional services that a small business is likely to need in order to comply with the proposed rule: The department is proposing certification requirements for 23-hour CRCs that provide behavioral health crisis relief services to minors. The proposed requirements amend existing certification standards that currently regulate 23-hour CRCs serving adults.

In 2023, the legislature passed 2SSB 5120 (chapter 433, Laws of 2023), establishing 23-hour CRCs in Washington state. At that time, by definition, CRCs were only meant to provide behavioral health crisis relief services to adults.

In 2024, the legislature passed E2SSB 5853 (chapter 367, Laws of 2024), amending the definition of "23-hour crisis relief center" in RCW 71.24.025 by removing the reference to adults and adding requirements in RCW 71.24.916 for CRCs that offer behavioral health crisis relief services to minors ages eight and older. CRCs are not required to treat minors, but if they do, they must comply with the additional certification standards.

Section 2(2) of E2SSB 5853 directs the department, in consultation with HCA and DCYF to establish in rule specific licensure and certification standards for CRCs that provide behavioral health crisis relief services to minors.

The proposed amendments include training standards for staff who treat minors; standards for consent to treat minors; policies on admission, treatment, and discharge of minors; and protocols for allowing a minor to stay beyond 23 hours and 59 minutes. The proposed amendments also add definitions of terms used in this section and update terms that are used in the context of healthcare.

By establishing these standards, the department is adding compliance requirements in rule for businesses that wish to provide CRC services to minors, including small businesses. However, with CRCs, it is mostly the statute (RCW 71.24.916) that will be dictating the professional services that a small business is likely to need, with the department either clarifying the statutory requirements in the proposed rules or building on these requirements for the sake of patient and staff safety. Throughout the rule-making process, the department has striven to balance the need for safety with permissiveness, which will give businesses the flexibility to determine a business model that will work best for their needs.

Portions of the rule language not requiring economic analysis: There are portions of the rule language in WAC 246-341-0903 that have been determined exempt from economic analysis based on the exemptions provided in RCW 34.05.310(4). The following SBEIS Table 2 identifies these portions of rule language.

Portions of the rule language requiring economic analysis: As defined in RCW 34.05.310, portions of the rule require economic analysis because this rule makes a significant change to a regulatory program. It is worth noting that there are no behavioral health agencies (BHA) licensed as a CRC at this time. The department is using data provided during key informant interviews during the development of the initial crisis relief center rules in 20241 and data provided from the update to chapter 246-341 WAC, completed in 2022.2

Description: Subsection (2)(f): The statute requires CRCs serving minors to "Be staffed 24 hours a day, seven days a week, with a pediatric multidisciplinary team." The proposed rule language requires staff serving minors to have documented training, experience, or credentials in the pediatric care applicable to the services they are providing. Note: This requirement is exempt from analysis for purposes of the significant legislative rule analysis under RCW 34.05.328 (5)(c)(i) but is not exempt from analysis for purposes of this SBEIS.

Cost(s): The proposed language establishes the process for verification of the statutory requirement of a pediatric multidisciplinary team. The department does not anticipate any additional cost to the CRC because it is a procedural rule that clarifies what is required by statute.

Description: Subsections (10)(b)(i)-(viii): The proposed language requires CRC staff who interact with minors to be trained in appropriate techniques for dealing with a minor's behavior and emotional crisis. The proposed language includes a list of topics that the training must cover.

Cost(s): Because the proposed rule does not specify the number of hours or method of training, the department estimates a cost impact range of $03 if CRC staff complete free training or already meet this requirement, up to $994 per staff member who interact with minors, if the CRC has staff obtain the training by a third party. It is also worth noting that training in these subjects could be received through continuing education in which case there would not be an additional cost to the CRC or CRC staff who are licensed health care providers. Furthermore, the CRC is not required to pay for training, in which case there would not be an additional cost to the CRC but to the CRC staff person.

Description: The following descriptions are regarding the discharge of minors which falls under subsection 12 of the proposed rule amendments. They have been separated into policies required for discharge of all minors, an additional policy for the discharge of minors ages eight to 12, and additional policies for the discharge of adolescents ages 13-17.

Subsections (12)(a)(i)-(viii): The proposed language requires CRCs who provide behavioral health crisis relief services to minors to develop and implement policies and procedures regarding discharge of minors including, but not limited to, discharge or transfer of a minor to another health care facility, DCYF assistance for parents unwilling to take custody of the minor, alternative discharge options if the minor is not a dependent of the state, contacting DCYF for minors that are a state dependent, contacting alternative legal guardians, coordination with local law enforcement, placement options for the dependent minor, and documentation of all discharge efforts.

Subsection (12)(b): The proposed language requires CRCs who provide behavioral health crisis relief services to minors to develop and implement an additional policy regarding discharge of minors ages eight through 12 [ensuring] that a discharge may only be to a parent or custodial guardian unless the parent has signed consent for an alternative discharge plan.

Subsections (12)(c)(i) and (ii): The proposed language requires CRCs who provide behavioral health crisis relief services to minors to develop and implement additional policies and procedures regarding discharge of adolescents ages 13-17 including referral to DCYF for adolescents experiencing homelessness and discharge of an adolescent without the supervision of a parent.

Cost(s): In 2022, the department adopted rules to streamline and improve licensing regulations and the licensing process for BHAs. As part of the cost-benefit analysis, a survey was conducted and BHAs were asked about the cost of updating all of the agencies' policies and procedures to reflect the most current WAC language. The data gathered reflected a significant variability in the estimates provided by each agency, with a median estimate for one-time or initial costs to update all the agency's policies and procedures of $3,200.

The department assumes that medical and health services managers5 ($53.21/hour) would develop the policies and procedures for discharge of a minor. The department estimates a one-time cost range to develop and implement 11 policies and procedures at one hour per policy, of $585.31 ($53.21/hr × 11 policies × 1 hr/policy) to no more than $3,200, the median cost reported to update all agency policies and procedures as provided in the 2022 cost-benefit analysis.

Summary of all cost(s):

Analysis on if the proposed rule may impose more-than-minor costs for businesses in the industry. Includes a summary of how the costs were calculated: The department determined that based on the proposed rule amendments, there is a one-time cost to CRCs that intend to provide crisis relief services to minors of $585.31 to $3,200 which would be less than the minor cost threshold of $4,376.75.

Summary of how the costs were calculated: The minor cost threshold for outpatient mental health and substance abuse centers as of 2022 is $4,376.75, based on 0.3 percent of average annual gross business income as calculated by data collected by the United States Bureau of Labor Statistics (SBEIS Table 1).

For the required staff training, the department researched multiple websites to find low to no cost training opportunities. The department considered that this may be no cost to the business if the employee is required to pay for the training. However, based on research, the department was able to find training courses that range from $0 to $99.

For the required policies for discharge of minors, the department took into account that there are eight policies for discharging all minors, one additional policy for discharging minors ages eight through 12, and two additional policies for discharging adolescents ages 13 through 17, making a total of 11 policies. Assuming that the staff who create these policies make $53.21/hr, that the policies take one hour to develop, and that there are 11 policies, the department calculated a probable cost of $585.31 to no more that $3,200, the median cost reported to update all agency policies and procedures as provided in the 2022 cost-benefit analysis.

A copy of the detailed cost calculations may be obtained by contacting Dan Overton, P.O. Box 47843, Olympia, WA 98504-7843, phone 564-201-0579, TTY 711, email dan.overton@doh.wa.gov.

August 1, 2025

Kristin Peterson, JD

Chief of Policy

for Dennis E. Worsham

Secretary of Health

RDS-6372.4