Behavioral Health Professions Legislative Implementation

In recent legislative sessions, several bills passed affecting behavioral health professionals, facilities, and agencies. Bills that require the Department of Health to take action to implement are listed below with a summary of the bill and who is impacted.

Substitute House Bill 1069 – Counseling compact (2023)

Who this effects 

Current and Future Licensed Mental Health Counselors. 

Summary  

The Counseling Compact is an interstate compact for Licensed Mental Health Counselors (LMHC) that authorizes interstate practice both in person and through telehealth for providers who hold a valid and unrestricted license in a compact member state. For the purposes of this compact, each provider who has been granted a privilege to practice in a compact member state must adhere to the laws and rules of the state where the client is located.  

The act creates the broad structure of the compact, but many details (such as the cost to states for participating in the compact) will be determined by the compact commission in the future.  Major features of the compact include: 

After the listening sessions department staff reviewed comments and drafted preliminary recommendations. We then held feedback sessions in August 2023 to gather responses from interested parties on the preliminary recommendations. You can watch the recordings of these sessions, or access the slides and handouts at the links below: 

• Requiring states to adopt the minimum standards for education, experience and examination; 
• Requiring applicants to establish a “home state” and seek practice privileges in other compact states;  
• Requiring state participation in a data sharing system; and  
• Allowing each state to enforce disciplinary authority. 

Substitute House Bill 1247 – Music therapists (2023) 

Who this affects

Individuals who provide music therapy in Washington. Music Therapy means the clinical and evidence-based use of music interventions to accomplish individualized goals by employing strategies and tools described in the law. 

Who is not affected

Nothing may be construed to prohibit or restrict any person licensed, certified, or regulated under the laws of Washington state in another profession or occupation incidental to the practice of that profession if the person does not represent that the person is a music therapist. See section 6 (2) of SHB 1247 for further exemptions. 

Summary

• Creates a new chapter in title 18 RCW to license and regulate music therapists. No person can practice music therapy without a license (or meeting an exception in law) beginning January 1, 2025 unless otherwise exempt. 
• An advisory committee is created to provide the department of health with expertise and assistance in developing regulations and establishing standards of practice. The department is authorized to establish and administer a program for consumer education in consultation with the committee. 
  • The department establishes rules to include specific academic and clinical training for licensure, as well as establishing fees. Licensure requires passing an examination administered or approved by the department. 

Engrossed Substitute House Bill 1394 – Youth sex offenders (2023) 

Who this effects 

Associate Level Licensed Counselors. 

Summary 

Sex Offender Treatment Providers (SOTP) and Sex Offender Treatment Provider Affiliates (SOTPA) are required to maintain dual licensure – primary licensure in a qualifying behavioral health profession and secondary licensure as an SOTP/SOTPA. HB 1394 expands the list of qualifying primary credentials for the SOTPA to include licensed counselor associates (Mental Health Counselor Associates, Marriage and Family Therapy Associates, Independent Clinical Social Workers Associates, and Advanced Social Work Associates. These credentials were valid underlying credentials until they were inadvertently removed from the statute by 2020 legislation. 

Second Substitute House Bill 1724 - Increasing the Behavioral Health Workforce (2023)

During the 2023 session, the legislature passed 2SHB 1724 (chapter 425, Laws of 2023) (PDF) to increase the behavioral health workforce by amending professional requirements. This bill also creates new projects for the department to: 

• Review licensing requirements, modify requirements in rule, and recommend changes to the legislature. The department is reviewing requirements for the following professions: 
  • licensed advanced social workers (LASW) 
  • licensed independent clinical social workers (LICSW) 
  • licensed marriage and family therapists (LMFT) 
  • licensed mental health counselors (LMHC) 
  • psychologists, and 
  • substance use disorder professionals (SUDP). 

The department must present initial recommendations to the legislature by November 1, 2023. Final recommendations are due November 1, 2024. 

• Adopt emergency rules implementing the above preliminary recommendations by July 1, 2024 and adopt permanent rules implementing recommendations by July 1, 2025. 
• Create a database to help place associates with supervisors by October 1, 2023. 
• Create a stipend program to lessen the costs associated with supervised experience hours. The department expects to complete this work by July 1, 2024. 
• Create two new Agency Affiliated Counselor (AAC) credentials – registered AAC and certified AAC. 

The bill also changes requirements for probationary licenses, experience, and supervision, including: 

• Removing requirements for probationary licensees to practice at a behavioral health agency. 
• Allowing social workers to earn a doctorate at any accredited university. 
• Reducing the supervised experience hours for LASWs and LICSWs. 
• Removing the requirement for LASWs that an LASW or LICSW must supervise at least 50 of their hours. 
• Removes the 2-year-minimum requirements for LMFTs to complete supervised experience hours. 

The bill also makes several changes that apply to all professions including: 

• Requiring disciplining authorities to waive education, training, experience, and exam requirements for applicants credentialed in another state with substantially equivalent standards. It also allows waiving requirements for applicants who have achieved national certification. 
• Removing the department’s authority to screen applicants before scheduling them for exams. 
• Granting the department authority to contract with third parties to review applications. 

Current Projects 

Section 5 of the bill directs the department to review licensing requirements for behavioral health professions. By November 1, 2023, we must recommend changes to statute that would reduce barriers, increase equity, and improve credentialing timelines. The department held listening sessions to help guide our research and recommendations in June 2023. You may access the slides presented during these listening sessions on our website (PDF).

Date	Time	Link to recording of session
June 6, 2023	10:30 a.m. - 12 p.m.	Session recording: English  American Sign Language  We apologize there is no Spanish recording of this session. We had technical difficulties in this session.
June 7, 2023	1:30 p.m. - 3 p.m.	Session recording: English  American Sign Language  Spanish
June 12, 2023	5 p.m. - 6:30 p.m.	Session recording: English  American Sign Language Spanish
June 15, 2023	5 p.m. - 6:30 p.m.	Session recording: English  American Sign Language   Spanish

After the listening sessions department staff reviewed comments and drafted preliminary recommendations. We then held feedback sessions in August 2023 to gather responses from interested parties on the preliminary recommendations. You can watch the recordings of these sessions, or access the slides and handouts at the links below: 

Webinar Date	Webinar Time	Recording	Slides
August 29, 2023	10 a.m. to Noon	English Spanish (audio only) ASL (video only)	Handouts: Feedback session slide deck (PDF) Draft Recommendations by profession (PDF) Draft Recommendations by type of change (PDF)
August 31, 2023	5 p.m. to 7 p.m.	English Spanish (audio only) ASL (video only)	Handouts: Feedback session slide deck (PDF) Draft Recommendations by profession (PDF) Draft Recommendations by type of change (PDF)

After the feedback sessions concluded and the survey period closed, department staff reviewed the feedback and made adjustments to the recommendations where appropriate. The department presented its  recommendations to the legislature on December 6, 2023. You can view the recording of the presentation here. The legislative presentation was limited by time, so we have also provided the following supporting documents, including the slides with additional context in the notes. 

• Final 2023 recommendations for statute and rule changes (PDF) 
• Final 2023 presentation to the legislature (PDF)

Department staff are now working to implement recommendations for rule changes via emergency rule, as required by Section 6 of 2SHB 1724. Emergency rules will be completed no later than July 1, 2024. Staff will also begin the process for permanent rulemaking during this time. 

The department must deliver a second round of recommendations to the legislature in Fall of 2024. Department staff hosted four listening sessions in April/May 2024. You can view the slides and recordings of the sessions below in English, Spanish, and ASL.

Webinar Date	Webinar Time	Recording	Slides
April 30, 2024	12 p.m. – 2 p.m.	English Spanish (audio only)  ASL	Listening Session-Behavioral Health Profession Licensure Requirements (PDF) Health Profession Credentialing Improvement (PDF)
April 30, 2024	5:30 p.m. – 7:30 p.m.	English Spanish (audio only)  ASL
May 1, 2024	5:30 p.m. – 7:30 p.m.	English Spanish (audio only)  ASL
May 2, 2024	11 a.m. – 1 p.m.	English Spanish (audio only)  ASL

If you were not able to attend the listening sessions, we would still like to hear from you! We are accepting written comments regarding barriers you have experienced until May 31, 2024. Please send any written comments to 1724publiccomment@doh.wa.gov.  

Department staff will spend the next several months reviewing the comments we received and considering statute and rule changes to help reduce barriers to entry or remaining in behavioral health practice. Once we have drafted recommendations, we will reach back out to interested parties for feedback sessions on the department’s draft proposals. These recommendations will be in addition to the recommendations made in December 2023. Please join our GovDelivery list for any of the included professions to be notified of future sessions. 

Upcoming Projects  

• Standard rulemaking – Many projects will need standard rules, including those begun by emergency rules. Standard rules include public workshops and hearings. They also allow the department to seek public input on the emergency rules already in place.  
• Section 6(2) – This rulemaking will permanently adopt the existing emergency rules from Section 6(1). The department will complete these rules by July 1, 2025.  
• Section 7(1) – This rulemaking will create rules about a database to help match associates with supervisors. It will also establish standards for supervision. The department expects to complete these permanent rules in late summer 2024.  
• Section 7(2) – This section directs the department to create a stipend program for supervisors that will help offset the costs of supervision. The goals is to reduce the impact of costs associated with gaining supervision hours for LMHCs, MFTs, LASWs, and LICSWs. The department expects to complete these rules by late summer 2024.  
• Sections 13-19 – This rulemaking project will permanently adopt the existing emergency rules to establish two new Agency Affiliated Counselor (AAC) license types.  This includes meeting with interested parties to create the permanent rules. The department expects to complete the permanent rules in Summer 2025.  

Completed Projects 

• Sections 1, 2, and 4 – These sections remove practice limitations on probationary licenses for psychologists, substance use disorder professionals, mental health counselors, marriage and family therapists, and social workers. Employment verification forms and related processes have been updated to remove these limitations. 
• Section 7(1) directs the department to create a database to help match associates to supervisors. Emergency rules for the database were adopted on September 28, 2023 and the database became available to associates on October 1, 2023.  
• Section 8 of the bill requires disciplining authorities for all professions to waive education, training, experience, and exam requirements for applicants who have been credentialed in another state with substantially equivalent licensing standards for at least two years immediately preceding their application. This licensing pathway became available to applicants on July 24, 2023. 
• Sections 13-19 – These sections expand the agency affiliated counselor (AAC) license type to include two new pathways: certified AACs and licensed AACs. The department has adopted emergency rules and a policy statement (PDF) implementing these two new credentials. They became available on July 24, 2023. Department staff will now begin work with interested parties on permanent rules for these two new license types. Please join our GovDelivery list to receive notifications about opportunities to engage with this effort.

Questions or comments? 

If you have any questions or comments, please contact us. 

Second Substitute Senate Bill 5120 – 23-hour crisis relief centers (2023) 

Summary

• 2SSB 5120 Establishes 23-hour crisis relief centers in Washington state.  
• Rules will need to be created and adopted in WAC 341-246 to accommodate. 
• "23-hour crisis relief center" means a community-based facility or portion of a facility serving adults, which is licensed or certified by the department of health and open 24 hours a day, seven days a week, offering access to mental health and substance use care for no more than 23 hours and 59 minutes at a time per patient, and which accepts all behavioral health crisis walk-ins, drop-offs from first responders, and individuals referred through the 988 system regardless of behavioral health acuity.
• For current updates, materials and links to workshops see the BHA Rules in Progress webpage.

Substitute Senate Bill 5189 – Behavioral health support specialist (2023) 

Who this effects 

Bachelors level behavioral health providers, students. 

Summary 

SB 5189 establishes the Behavioral Health Support Specialist credential, a new bachelor’s level profession that provides low intensity intervention for clients with mild to moderate behavioral health conditions. They would provide brief, evidence-based interventions and monitor treatment outcomes; they could not diagnose. They would work under the supervision of a licensed healthcare provider, including at a licensed community behavioral health agency (BHA).  The scope of the profession would be based on curriculum developed by the University of Washington, which is required to collaborate with the department on rulemaking. 

The bill follows a conclusion made by a 2019 report (a quasi-Sunrise Review) about the need for a pathway to a bachelor’s level behavioral health credential. A new credential would integrate substance use and mental health treatment, create a career path for advancement for SUDPs, and potentially improve worker retention. In addition, the bill:  

• limits the scope of treatment,  
• prohibits diagnosis,  
• covers services under Medicaid and private insurance, and 
• requires supervised practice. 

Second Substitute Senate Bill 5555 – Certified peer specialists (2023) 

Who this affects 

Agency Affiliated Counselors (AAC) working as Peer Counselors, independent Peer Counselors, Behavioral Health Agencies 

Summary 

• Creates two new credentials, Certified Peer Specialists and Certified Peer Specialists Trainees. This will eventually replace the AAC Peer Counselors by January 1, 2027.   
• These are independent credentials that can work outside of a BHA setting, can bill insurance independently, and can be supervised by other peers.   
• The credential is also voluntary, however non-credentialed individuals cannot bill insurance.  

What are the next steps? 

• The department will file a CR-101 form to officially begin the rulemaking process.  
• The department will reach out to various peer groups and BHAs in Washington state to provide input on the rulemaking process. The advisory committee was removed by the governor with a mandate for the department to ensure there is extensive community outreach.   
• The Health Care Authority (HCA) is also heavily involved with this profession, as they need to provide the training and examination required for the credential. They must also develop a peer supervisor training course and a peer crisis response services training course.  
• The department will host several rulemaking workshops and solicit ideas and feedback around the creation of the profession. The peer specialist credentials must be made available by July 1, 2025. 

Substitute House Bill 1286 – Psychology compact (2022) 

Who this affects 

Psychologists 

Summary  

• PSYPACT is an interstate psychology compact that allows qualified psychologists from participating states to provide telehealth services and temporary in-person services to residents of other participating states. Washington state was added as a participating state in this psychology interjurisdictional compact (PSYPACT). 
• Washington residents are able to receive services from out-of-state psychologists participating in the compact and Washington psychologists are able to apply to the PSYPACT Commission for authorization to provide services through the compact.  
• Washington licensed psychologists who wish to join the compact must apply through PSYPACT.  
• Became effective as of June 9, 2022. 

Engrossed Second Substitute House Bill 1504 – Workforce Education Investment Act (2021) 

Who this affects 

Student Interns in counseling programs, Agency Affiliated Counselors, Behavioral Health Agencies  

Summary 

• Requires the department to allow student interns to practice as Agency Affiliated Counselors (AAC) if they are working in a Behavioral Health Agency.   
• The department is working with stakeholders to define “student intern”.  

What has been completed so far? 

• A policy was implemented in July 2021 to allow student interns to immediately begin practicing while the department conducts rulemaking.  
• The department has conducted a workshop to get feedback on how to define student interns. More workshops will be held in the future.  

What are the next steps? 

• This rulemaking will be impacted by current legislation that also changes the AAC rules. There is a high likelihood that this CR-101 will be closed and re-opened with the AAC rulemaking required in 2SHB 1724. 
• Workshops will be conducted to address components of both pieces of legislation together. 

Substitute House Bill 2426 – Patient safety in psychiatric hospitals (2020)

Who this affects

Psychiatric hospitals, other department-licensed facilities

Summary

• Expands the department's regulatory enforcement tools for psychiatric hospitals
• Provides the department authority to impose stop placements on admissions, civil fines, and conditions on a psychiatric hospital license
• Allows the department to make certain actions (stop placements, conditions on a license, and license suspension) effectively immediately pending a hearing when there is immediate jeopardy to patients
• The department must make technical assistance and training available to psychiatric hospitals on request
• Inspection and investigation reports for health care facilities must be posted on the Web.
• The department must work with stakeholders to make legislative recommendations for consolidation and standardization of licensing and enforcement requirements for all.

Substitute House Bill 2883 – Adolescent behavioral health care act (2020)

Who this affects

Residential treatment facilities providing services to adolescents

Summary

• Clarifies that parents and guardians may bring their child to any residential treatment facility for family initiated treatment and allows the adolescent to remain in treatment in a residential treatment facility as long as it is medically necessary
• Health Care Authority must develop and operate a data collection and tracking system for youth receiving family-initiated treatment and collaborate with DOH on collecting data from facilities providing family-initiated treatment.

Second Engrossed Second Substitute Senate Bill 5720 – Involuntary treatment act (2020)

Who this affects

Behavioral health agencies certified to provide evaluation and treatment services

Summary

• Updates terms to reflect integration of mental health and substance use disorder
• Changes initial detention time period from 72 hours to 120 hours (effective 1/2021)
• Aligns youth involuntary detention more closely with requirements for adult involuntary detention
• Changes statutes to streamline the process to admit patients for involuntary treatment.
• The Department is required to participate in an Involuntary Treatment Act Workgroup which will be facilitated by the Health Care Authority

Second Substitute House Bill 1394 – facilities needed for continuum of care for behavioral health patients (2019)

Who this affects

Behavioral health agencies

Summary

• Requires the department to establish licensing and certification rules for intensive behavioral health treatment facilities and mental health peer respite centers, and encourages improving access to care for people on a 90- or 180-day civil commitment order.

What has been completed so far?

• On July 30, 2019, DOH filed a CR-101 document with the intent to do rulemaking to implement this legislation. A series of workshops have been held to gather public input in developing draft rule language.
• On December 17, 2019 the CR-102 for this project was filed and a public hearing was held on January 22, 2020.
• On March 17, 2020, the CR-103 (PDF) for this project was filed and the effective date of the new rules will be May 1, 2020.
• See the behavioral health rules in progress page for more information.

Second Substitute House Bill 1907 – Substance use disorder treatment systems (2019)

Who this affects

Agency affiliated counselors practicing as a certified peer counselor and behavioral health facilities and agencies

Summary

• Allows for certified peer counselors participating in a substance abuse monitoring program to complete only one year in the program in order to meet the program graduation requirements, and a certified peer counselor with less than one year of recovery would be required to participate in a substance abuse monitoring program only until reaching the one-year mark.
• Behavioral health facilities and agencies that care for vulnerable adults may not automatically deny employment to an applicant for an agency affiliated counselor position practicing as a certified peer counselor provided that at least one year has passed since conviction; that the offense was the result of substance abuse or untreated mental health symptoms; and that the applicant has been in recovery for at least one year.
• The department is tasked with conducting a sunrise review (PDF) to evaluate the need for creating an advanced peer counselor support specialist credential.

What has been completed so far?

• On August 27, 2019, a series of CR-101 documents (PDF) were submitted for all affected professions. A series of workshops have been held to gather public input in developing draft rule language. See the behavioral health rules in progress page for more information.
• The application for licensure as an agency affiliated counselor was revised to include a checkbox to identify if an agency affiliated counselor is employed as a peer counselor. The application has also been revised to include an attestation to confirm that an applicant employed as a peer counselor has been in recovery from substance use disorder for more than one year. See the revised application on the Agency Affiliated Counselor webpage.
• Draft versions of the sunrise reports have been completed and are available on the Reports and Guidance Documents webpage.
• On March 18, 2020, the CR-102 (PDF) was submitted for all affected professions, and a public hearing date of April 21, 2020, has been scheduled. Please note that in response to the Coronavirus (COVID-19) public health emergency, the Department of Health will not provide a physical location for this hearing to promote social distancing and the safety of the citizens of Washington. A virtual public hearing, without a physical meeting space, will be held instead. For information on how to participate in this hearing, see our Rules in Progress webpage.

• On April 21, 2020, the public hearing was held virtually and the completed draft language was presented. Comments and suggestions were received and the rules were finalized. The CR-103 (PDF) was submitted for all affected professions and the rules went into effect on July 1, 2020. Updates for individual profession webpages included information regarding the changes from the implementation of this bill and necessary forms and application updates were posted.