Residential Treatment Facilities (RTF)

Residential treatment facilities (RTF) are licensed, community-based facilities that provide 24-hour inpatient care for people with mental health and/or chemical dependency disorders in a residential treatment setting.

Licensing Information

All licensing applications are reviewed within a few days of receipt. If there is missing or incomplete information, a Department of Health staff member will notify you via the email address on the application. If you didn't provide an email address, the department will mail you a letter.

Processing time varies for each application. It depends on how complete the application is, and how quickly the licensing requirements are met.

Apply initially, amend or renew a license

Behavioral Health Treatment Options for Adolescents

Behavioral health treatment options for adolescents-HCA (PDF)

EMS Guidelines Transport to Behavioral Health Facilities

The Washington State Department of Health (department), developed this guideline (PDF) to provide direction to regional emergency medical service (EMS) & trauma care councils for developing patient care procedures, local EMS councils with developing county operating procedures and EMS physician medical program directors (MPD) in developing their prehospital patient care protocols for EMS transport to behavioral health facilities.

Residential Treatment Facility Resource Guide

Resource guide (PDF)

Health Care Entity (HCE) License and Automated Drug Distribution Devices (ADDD)

Health Care Entity (HCE) License and Automated Drug Distribution Devices (ADDD) Frequently Asked Questions

Inspection Process

The state licenses more than 100 residential treatment facilities to provide care within the minimum health and safety standards established by state law. The Department of Health is required to inspect these facilities as part of the initial licensing process and at regular intervals.

Our inspection staff includes both nurses and public health advisers. Nurses assess the clinical aspects of the facility. Public health advisers inspect the physical aspects for environment of care issues. In addition, we contract with the state fire marshal to inspect for fire, life and safety standards.

Our inspectors are trained to inspect facilities to confirm compliance with appropriate state regulatory standards in Chapter 246-337 WAC, Chapter 246-215 WAC and Chapter 71.12 RCW. They look for indications of deficiencies that pose patient safety risks.

After the inspection is completed, the facility is provided with a report indicating the standards that were met and the deficiencies that were identified. The inspection team works with the facility to explain how the deficiencies were identified and requires that the facility provide an adequate written plan for addressing the deficiencies. For example: WAC 246-341 Policy and Procedure Review Tool (PDF).

Applicable Regulations

Chapter 71.12 RCW – Private Establishments. In this chapter "establishment" and "institution" mean and include every private or county or municipal hospital, including public hospital districts, sanitariums, homes, or other place receiving or caring for any mentally ill, mentally incompetent person or chemically dependent person.
Chapter 246-337 WAC – Residential Treatment Facility. This chapter sets the minimum health and safety standards for licensure and operations of 24-hour private, county or municipal residential treatment facilities (RTF) providing healthcare services to people with mental disorders or substance abuse.

Recent Legislation Affecting RTFs

Second Substitute Senate Bill 6228 – This bill passed in the 2024 Legislative Session and amended RCW 71.24.037 and 2023 c 454 s2 and added a new section that effects RTFs in the following ways:

Model Policy RCW 71.24.847 Transfer of clients—Policy and statistic reporting. This change requires the department to adopt a model policy for licensed or certified behavioral health agencies providing voluntary inpatient or residential substance use disorder treatment services or withdrawal management services to consider when adopting policies related to the transfer or discharge of a person without the person's consent from a facility providing those services (PDF). This is a model only and facilities are encouraged to create their own policy.

It also requires that, beginning July 1, 2025, every licensed or certified behavioral health agency providing voluntary inpatient or residential substance use disorder treatment services or withdrawal management services shall submit a report to the department for each instance in which a person receiving services either: (i) Was transferred or discharged from the facility by the agency without the person's consent; or (ii) released the person's self from the facility prior to a clinical determination that the person had completed treatment. This report is a new requirement to specific RTFs and a link to the required forms are forthcoming to this space.

RCW 28B.20.550 Alcohol use disorder decision-making tool. This made changes requiring the addictions, drug, and alcohol institute at the University of Washington to create a patient shared decision-making tool to assist behavioral health and medical providers when discussing medication treatment options for patients with alcohol use disorder. The institute will distribute the tool to behavioral health and medical providers and instruct them on ways to incorporate the use of the tool into their practices. This is a tool only, is not required by the Department though positively anticipated and facilities are encouraged to evaluate how they may utilize the tool. Once the tool is finalized there will be a link at this space.

Current Topics

Notice of Emergency Rule filing. The Department of Health adopted an emergency rule (PDF) clarifying that all health care facilities licensed by the department must comply with state and federal statutes, administrative rules, lawful orders, and other legal requirements relating to the operation of the facility and the control or prevention of the spread of coronavirus disease 2019 (COVID-19), including orders issued by the governor, by the secretary of health, by a local board of health, and by a local health officer. The new rule applies to all health care facilities licensed by the department, which includes: acute care hospitals, ambulatory surgical facilities, behavioral health agencies, birthing centers, in-home services agencies, medical test sites, psychiatric hospitals, and residential treatment facilities.
Check out our new Behavioral Health Professions, Facilities, and Agencies webpages. These new webpages provide a one-stop-shop for finding information on both behavioral health professions and facilities work. You may find the legislative implementation and rules in progress pages very helpful.
The department constantly updating WACs and does so with the input of all that are interested and have a stake in the decisions. You may find out what is new and upcoming on our rules workshops webpage.
The Department of Commerce has announced the opening of the most recent Behavioral Health Facilities Grant program. This program is open to nonprofits, public entities, tribes and for-profit businesses. These grants are for capital construction costs only. More information about this program and links to the online applications are online.
The Centers for Disease Control and Prevention has updated the guidelines for health care worker Tuberculosis screening. The Department of Health has issued policy statement allowing residential treatment facilities to implement these updated guidelines (PDF).
Health care entity (HCE) licensing is now available for RTFs allowing the use of automated drug distribution devices (ADDDs). See the Health Care Entity License and Automated Drug Distribution Devices frequently asked questions for more information.