title: RCW 71.24.916

text:
(1) The secretary shall license or certify 23-hour crisis relief centers that meet state minimum standards. The department shall create rules in consultation with the authority by January 1, 2024, to develop standards for licensure or certification of 23-hour crisis relief centers.
(a) The rules, at a minimum, must require the 23-hour crisis relief center to:
(i) Offer walk-in options and drop-off options for first responders and persons referred through the 988 system, without a requirement for medical clearance for these individuals. The facility must be structured to have the capacity to accept admissions 90 percent of the time when the facility is not at its full capacity, and to have a no-refusal policy for law enforcement, with instances of declined admission and the reasons for the declines tracked and made available to the department;
(ii) Provide services to address mental health and substance use crisis issues;
(iii) Maintain capacity to screen for physical health needs, deliver minor wound care for nonlife-threatening wounds, and provide care for most minor physical or basic health needs that can be addressed without need for medical diagnosis or health care prescriber orders, with an identified pathway to transfer the person to more medically appropriate services if needed;
(iv) Be staffed 24 hours a day, seven days a week, with a multidisciplinary team capable of meeting the needs of individuals experiencing all levels of crisis in the community, which includes access to a prescriber and the ability to dispense medications appropriate for 23-hour crisis relief center clients;
(v) Screen all individuals for suicide risk and engage in comprehensive suicide risk assessment and planning when clinically indicated;
(vi) Screen all individuals for violence risk and engage in comprehensive violence risk assessment and planning when clinically indicated;
(vii) Limit patient stays to a maximum of 23 hours and 59 minutes except for patients waiting on a designated crisis responder evaluation or making an imminent transition to another setting as part of an established aftercare plan. Exceptions to the time limit made under this subsection shall not cause a 23-hour crisis relief center to be classified as a residential treatment facility under RCW 71.12.455;
(viii) Maintain relationships with entities capable of providing for reasonably anticipated ongoing service needs of clients, unless the licensee itself provides sufficient services; and
(ix) When appropriate, coordinate connection to ongoing care.
(b) The rules, at a minimum, must develop standards for determining medical stability before an emergency medical services drop-off.
(c) The rules must include standards for the number of recliner chairs that may be licensed or certified in a 23-hour crisis relief center and the appropriate variance for temporarily exceeding that number in order to provide the no-refusal policy for law enforcement.
(d) The department shall specify physical environment standards for the construction review process that are responsive to the unique characteristics of the types of interventions used to provide care for all levels of acuity in facilities operating under the 23-hour crisis relief center model. In a 23-hour crisis relief center which proposes to serve both child and adult clients in the same facility, these standards must include separate internal entrances, spaces, and treatment areas such that no contact occurs between child and adult 23-hour crisis relief center clients.
(e) The department shall coordinate with the authority and department of social and health services to establish rules that prohibit facilities that are licensed or required to be licensed under chapter 18.51, 18.20, 70.97, 72.36, or 70.128 RCW from discharging or transferring a resident to a 23-hour crisis relief center.
(f) The department shall coordinate with the authority to establish rules that prohibit a hospital that is licensed under chapter 70.41 RCW from discharging or transferring a patient to a 23-hour crisis relief center unless the hospital has a formal relationship with the 23-hour crisis relief center.
(g) The authority shall take steps necessary to make 23-hour crisis relief center services, including on-site physical health care, eligible for medicaid billing to the maximum extent allowed by federal law.
(2) By March 31, 2025, the secretary shall amend licensure and certification rules for 23-hour crisis relief clinics in consultation with the authority and the department of children, youth, and families to create standards for licensure or certification of 23-hour crisis relief centers which provide services to children. To meet the needs of children in crisis and their families, 23-hour crisis relief centers treating children must, in addition to meeting the requirements of subsection (1) of this section:
(a) Not treat children in a shared space or allow them to have contact with adult clients;
(b) Be structured to meet the crisis needs of children ages eight and over and their families;
(c) Have written policies and procedures defining how different age groups will be appropriately separated;
(d) Provide resources to connect children and their families with behavioral health supports;
(e) Coordinate with the department of children, youth, and families for children who do not need inpatient care and are unable to be discharged to home;
(f) Address discharge planning for a child who is at risk of dependency, out-of-home placement, or homelessness; and
(g) Be staffed 24 hours a day, seven days a week, with a pediatric multidisciplinary team.
(3) The secretary shall solicit input from stakeholders when engaging in rule making under subsection (2) of this section.
[ 2024 c 367 s 2; 2023 c 433 s 2.]
Notes:
Rules—2023 c 433 s 2: "When making rules under section 2 of this act, the department of health shall consult with stakeholders including, but not limited to: The Washington council for behavioral health; WAADAC, the voice for Washington state addiction professionals persons with lived experience of behavioral health crisis; family members with lived experience of caring for someone in behavioral health crisis; the Washington state hospital association; the American college of emergency physicians; behavioral health administrative services organizations; the Washington association of designated crisis responders; the Washington association of sheriffs and police chiefs; and an individual or entity representing emergency medical services." [ 2023 c 433 s 22.]

catchline: 23-hour crisis relief centers—Licensing and certification—Rules—Standards.


doc_type: statute

jurisdiction: wa

title: RCW 71.24.920

text:
(1)(a) By January 1, 2025, the authority must develop a course of instruction to become a certified peer support specialist under chapter 18.420 RCW. The course must be approximately 80 hours in duration and based upon the curriculum offered by the authority in its peer counselor training as of July 23, 2023, as well as additional instruction in the principles of recovery coaching and suicide prevention. The authority shall establish a peer engagement process to receive suggestions regarding subjects to be covered in the 80-hour curriculum beyond those addressed in the peer counselor training curriculum and recovery coaching and suicide prevention curricula, including the cultural appropriateness of the 80-hour training. The education course must be taught by certified peer support specialists. The education course must be offered by the authority with sufficient frequency to accommodate the demand for training and the needs of the workforce. The authority must establish multiple configurations for offering the education course, including offering the course as an uninterrupted course with longer class hours held on consecutive days for students seeking accelerated completion of the course and as an extended course with reduced daily class hours, possibly with multiple days between classes, to accommodate students with other commitments. Upon completion of the education course, the student must pass an oral examination administered by the course trainer.
(b) The authority shall develop an expedited course of instruction that consists of only those portions of the curriculum required under (a) of this subsection that exceed the authority's certified peer counselor training curriculum as it exists on July 23, 2023. The expedited training shall focus on assisting persons who completed the authority's certified peer counselor training as it exists on July 23, 2023, to meet the education requirements for certification under RCW 18.420.050.
(2) By January 1, 2025, the authority must develop a training course for certified peer support specialists providing supervision to certified peer support specialist trainees under RCW 18.420.060.
(3)(a) By July 1, 2025, the authority shall offer a 40-hour specialized training course in peer crisis response services for individuals employed as peers who work with individuals who may be experiencing a behavioral health crisis. When offering the training course, priority for enrollment must be given to certified peer support specialists employed in a crisis-related setting, including entities identified in (b) of this subsection. The training shall incorporate best practices for responding to 988 behavioral health crisis line calls, as well as processes for co-response with law enforcement when necessary.
(b) Beginning July 1, 2025, any entity that uses certified peer support specialists as peer crisis responders, may only use certified peer support specialists who have completed the training course established by (a) of this subsection. A behavioral health agency that uses certified peer support specialists to work as peer crisis responders must maintain the records of the completion of the training course for those certified peer support specialists who provide these services and make the records available to the state agency for auditing or certification purposes.
(4) By July 1, 2025, the authority shall offer a course designed to inform licensed or certified behavioral health agencies of the benefits of incorporating certified peer support specialists and certified peer support specialist trainees into their clinical staff and best practices for incorporating their services. The authority shall encourage entities that hire certified peer support specialists and certified peer support specialist trainees, including licensed or certified behavioral health agencies, hospitals, primary care offices, and other entities, to have appropriate staff attend the training by making it available in multiple formats.
(5) The authority, in consultation with the office of crime victims advocacy established under RCW 43.280.080, must contract with one or more training entities for the development of three separate courses of instruction related to the provision of peer support services to persons who have experienced domestic violence, sexual assault, or human trafficking. The authority shall collaborate with people with lived and living experience in the development of the courses. The courses must supplement the instruction received by certified peer support specialists and incorporate competencies that are typically taught in training programs for victim advocates, including safety planning, a foundational understanding of domestic violence, sexual assault, or human trafficking, as applicable, and advocacy across legal, medical, social services, and other systems.
(6) The authority shall:
(a) Hire clerical, administrative, investigative, and other staff as needed to implement this section to serve as examiners for any practical oral or written examination and assure that the examiners are trained to administer examinations in a culturally appropriate manner and represent the diversity of applicants being tested. The authority shall adopt procedures to allow for appropriate accommodations for persons with a learning disability, other disabilities, and other needs and assure that staff involved in the administration of examinations are trained on those procedures;
(b) Develop oral and written examinations required under this section. The initial examinations shall be adapted from those used by the authority as of July 23, 2023. The authority shall assure that the examinations are culturally appropriate;
(c) Prepare, grade, and administer, or supervise the grading and administration of written examinations for obtaining a certificate;
(d) Approve entities to provide the educational courses required by this section and approve entities to prepare, grade, and administer written examinations for the educational courses required by this section;
(e) Develop examination preparation materials and make them available to students enrolled in the courses established under this section in multiple formats, including specialized examination preparation support for students with higher barriers to passing the written examination; and
(f) Administer, through contract, a program to link eligible persons in recovery from behavioral health challenges who are seeking employment as peers with employers seeking to hire peers, including certified peer support specialists. The authority must contract for this program with an organization that provides peer workforce development, peer coaching, and other peer supportive services. The contract must require the organization to create and maintain a statewide database which is easily accessible to eligible persons in recovery who are seeking employment as peers and potential employers seeking to hire peers, including certified peer support specialists. The program must be fully implemented by July 1, 2024.
(7) For the purposes of this section:
(a) "Peer crisis responder" means a peer support specialist certified under chapter 18.420 RCW who has completed the training under subsection (3) of this section whose job involves responding to behavioral health emergencies, including those dispatched through a 988 crisis hotline or the 911 system.
(b) "Victim services agency" means a program or organization that provides, as its primary purpose, assistance and advocacy for persons who have experienced domestic violence, sexual assault, or human trafficking. Services may include crisis intervention, individual and group support, information, referrals, and safety planning.
[ 2025 c 360 s 3; 2023 c 469 s 13.]
Notes:

license: public-domain-government-work

rule_set: Revised Code of Washington

catchline: Certified peer support specialists—Courses of instruction—Duties.

code: rcw

unit: section

court: Washington State Legislature


title: RCW 71.24.922

text:
Behavioral health agencies must reduce the caseload for approved supervisors who are providing supervision to certified peer support specialist trainees seeking certification under chapter 18.420 RCW.
[ 2025 c 360 s 21; 2023 c 469 s 14.]
Notes:

catchline: Certified peer support specialists—Supervision caseload reduction.


title: RCW 71.24.924

text:
(1) Beginning January 1, 2027, a person who engages in the practice of peer support services and who bills a health carrier or medical assistance or whose employer bills a health carrier or medical assistance for those services must hold an active credential as a certified peer support specialist or certified peer support specialist trainee under chapter 18.420 RCW.
(2) A person who is registered as an agency affiliated counselor under chapter 18.19 RCW who engages in the practice of peer support services and whose agency, as defined in RCW 18.19.020, bills medical assistance for those services must hold a certificate as a certified peer support specialist or certified peer support specialist trainee under chapter 18.420 RCW no later than January 1, 2027.
[ 2025 c 360 s 22; 2023 c 469 s 15.]

catchline: Certified peer support specialists—Billing.


title: RCW 71.28.010

text:
Any county, or city within a county which is situated on the state boundaries is authorized to contract for mental health services with a county situated in either the states of Oregon or Idaho, located on the boundaries of such states with the state of Washington.
[ 1988 c 176 s 911; 1977 ex.s. c 80 s 44; 1967 c 84 s 1.]
Notes:
Purpose—Intent—Severability—1977 ex.s. c 80: See notes following RCW 4.16.190.

catchline: Contracts by boundary counties or cities therein.


title: RCW 71.32.010

text:
(1) The legislature declares that an individual with capacity has the ability to control decisions relating to his or her own behavioral health care. The legislature finds that:
(a) Some behavioral health disorders cause individuals to fluctuate between capacity and incapacity;
(b) During periods when an individual's capacity is unclear, the individual may be unable to access needed treatment because the individual may be unable to give informed consent;
(c) Early treatment may prevent an individual from becoming so ill that involuntary treatment is necessary; and
(d) Individuals with behavioral health disorders need some method of expressing their instructions and preferences for treatment and providing advance consent to or refusal of treatment.
(2) The legislature recognizes that a mental health advance directive can be an essential tool for an individual to express his or her choices at a time when the effects of a behavioral health disorder have not deprived him or her of the power to express his or her instructions or preferences.
(3) The legislature further finds that:
(a) A mental health advance directive must provide the individual with a full range of choices;
(b) Individuals with behavioral health disorders have varying perspectives on whether they want to be able to revoke a directive during periods of incapacity;
(c) For a mental health advance directive to be an effective tool, individuals must be able to choose how they want their directives treated during periods of incapacity; and
(d) There must be clear standards so that treatment providers can readily discern an individual's treatment choices.
Consequently, the legislature affirms that, pursuant to other provisions of law, a validly executed mental health advance directive is to be respected by agents, guardians, and other surrogate decision makers, health care providers, professional persons, and health care facilities.
[ 2021 c 287 s 1; 2003 c 283 s 1.]

catchline: Legislative declaration—Findings.


title: RCW 71.32.020

text:
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Adult" means any individual who has attained the age of majority or is an emancipated minor.
(2) "Agent" has the same meaning as an attorney-in-fact or agent as provided in chapter 11.125 RCW.
(3) "Behavioral health disorder" means a mental disorder, a substance use disorder, or a co-occurring mental health and substance use disorder.
(4) "Capacity" means that a person has not been found to be incapacitated pursuant to this chapter or subject to a guardianship under RCW 11.130.265.
(5) "Court" means a superior court under chapter 2.08 RCW.
(6) "Health care facility" means a hospital, as defined in RCW 70.41.020; an institution, as defined in RCW 71.12.455; a state hospital, as defined in RCW 72.23.010; a nursing home, as defined in RCW 18.51.010; or a clinic that is part of a community behavioral health service delivery system, as defined in RCW 71.24.025.
(7) "Health care provider" means an osteopathic physician licensed under chapter 18.57 RCW, a physician or physician's assistant licensed under chapter 18.71 or 18.71A RCW, or an advanced registered nurse practitioner licensed under *RCW 18.79.050.
(8) "Incapacitated" means a person who: (a) Is unable to understand the nature, character, and anticipated results of proposed treatment or alternatives; understand the recognized serious possible risks, complications, and anticipated benefits in treatments and alternatives, including nontreatment; or communicate his or her understanding or treatment decisions; or (b) has been found to be subject to a guardianship under RCW 11.130.265.
(9) "Informed consent" means consent that is given after a person: (a) Is provided with a description of the nature, character, and anticipated results of proposed treatments and alternatives, and the recognized serious possible risks, complications, and anticipated benefits in the treatments and alternatives, including nontreatment, in language that the person can reasonably be expected to understand; or (b) elects not to be given the information included in (a) of this subsection.
(10) "Long-term care facility" has the same meaning as defined in RCW 43.190.020.
(11) "Mental disorder" means any organic, mental, or emotional impairment which has substantial adverse effects on an individual's cognitive or volitional functions.
(12) "Mental health advance directive" or "directive" means a written document in which the principal makes a declaration of instructions or preferences or appoints an agent to make decisions on behalf of the principal regarding the principal's mental health treatment, or both, and that is consistent with the provisions of this chapter.
(13) "Mental health professional" means a psychiatrist, psychologist, psychiatric nurse, or social worker, and such other mental health professionals as may be defined by rules adopted by the secretary pursuant to the provisions of chapter 71.05 RCW.
(14) "Principal" means a person who has executed a mental health advance directive.
(15) "Professional person" means a mental health professional and shall also mean a physician, registered nurse, and such others as may be defined by rules adopted by the secretary pursuant to the provisions of chapter 71.05 RCW.
(16) "Social worker" means a person with a master's or further advanced degree from a social work educational program accredited and approved as provided in RCW 18.320.010.
(17) "Substance use disorder" means a cluster of cognitive, behavioral, and physiological symptoms indicating that an individual continues using the substance despite significant substance-related problems. The diagnosis of a substance use disorder is based on a pathological pattern of behaviors related to the use of the substances.
[ 2021 c 287 s 4; (2021 c 287 s 3 expired July 1, 2022); (2021 c 287 s 2 expired January 1, 2022). Prior: 2020 c 312 s 732; 2020 c 80 s 53; 2016 c 209 s 407; 2011 c 89 s 15; 2003 c 283 s 2.]
Notes:
Reviser's note: *(1) RCW 18.79.050 was amended by 2024 c 239 s 3, changing "advanced registered nurse practitioner" to "advanced practice registered nurse," effective June 30, 2027.
(2) The definitions in this section have been alphabetized pursuant to RCW 1.08.015(2)(k).
Effective date—2021 c 287 s 4: "Section 4 of this act takes effect July 1, 2022." [ 2021 c 287 s 25.]
Effective date—2021 c 287 s 3: "Section 3 of this act takes effect January 1, 2022." [ 2021 c 287 s 23.]
Expiration date—2021 c 287 s 3: "Section 3 of this act expires July 1, 2022." [ 2021 c 287 s 24.]
Expiration date—2021 c 287 s 2: "Section 2 of this act expires January 1, 2022." [ 2021 c 287 s 22.]
Effective dates—2020 c 312: See note following RCW 11.130.915.
Effective date—2020 c 80 ss 12-59: See note following RCW 7.68.030.
Intent—2020 c 80: See note following RCW 18.71A.010.
Short title—Application—Uniformity—Federal law application—Federal electronic signatures in global and national commerce act—Application—Dates—Effective date—2016 c 209: See RCW 11.125.010 and 11.125.900 through 11.125.903.
Effective date—2011 c 89: See note following RCW 18.320.005.
Findings—2011 c 89: See RCW 18.320.005.
PDF
RCW 71.32.020
Definitions. (Effective June 30, 2027.)
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Adult" means any individual who has attained the age of majority or is an emancipated minor.
(2) "Agent" has the same meaning as an attorney-in-fact or agent as provided in chapter 11.125 RCW.
(3) "Behavioral health disorder" means a mental disorder, a substance use disorder, or a co-occurring mental health and substance use disorder.
(4) "Capacity" means that a person has not been found to be incapacitated pursuant to this chapter or subject to a guardianship under RCW 11.130.265.
(5) "Court" means a superior court under chapter 2.08 RCW.
(6) "Health care facility" means a hospital, as defined in RCW 70.41.020; an institution, as defined in RCW 71.12.455; a state hospital, as defined in RCW 72.23.010; a nursing home, as defined in RCW 18.51.010; or a clinic that is part of a community behavioral health service delivery system, as defined in RCW 71.24.025.
(7) "Health care provider" means an osteopathic physician licensed under chapter 18.57 RCW, a physician or physician's assistant licensed under chapter 18.71 or 18.71A RCW, or an advanced practice registered nurse licensed under RCW 18.79.050.
(8) "Incapacitated" means a person who: (a) Is unable to understand the nature, character, and anticipated results of proposed treatment or alternatives; understand the recognized serious possible risks, complications, and anticipated benefits in treatments and alternatives, including nontreatment; or communicate his or her understanding or treatment decisions; or (b) has been found to be subject to a guardianship under RCW 11.130.265.
(9) "Informed consent" means consent that is given after a person: (a) Is provided with a description of the nature, character, and anticipated results of proposed treatments and alternatives, and the recognized serious possible risks, complications, and anticipated benefits in the treatments and alternatives, including nontreatment, in language that the person can reasonably be expected to understand; or (b) elects not to be given the information included in (a) of this subsection.
(10) "Long-term care facility" has the same meaning as defined in RCW 43.190.020.
(11) "Mental disorder" means any organic, mental, or emotional impairment which has substantial adverse effects on an individual's cognitive or volitional functions.
(12) "Mental health advance directive" or "directive" means a written document in which the principal makes a declaration of instructions or preferences or appoints an agent to make decisions on behalf of the principal regarding the principal's mental health treatment, or both, and that is consistent with the provisions of this chapter.
(13) "Mental health professional" means a psychiatrist, psychologist, psychiatric nurse, or social worker, and such other mental health professionals as may be defined by rules adopted by the secretary pursuant to the provisions of chapter 71.05 RCW.
(14) "Principal" means a person who has executed a mental health advance directive.
(15) "Professional person" means a mental health professional and shall also mean a physician, registered nurse, and such others as may be defined by rules adopted by the secretary pursuant to the provisions of chapter 71.05 RCW.
(16) "Social worker" means a person with a master's or further advanced degree from a social work educational program accredited and approved as provided in RCW 18.320.010.
(17) "Substance use disorder" means a cluster of cognitive, behavioral, and physiological symptoms indicating that an individual continues using the substance despite significant substance-related problems. The diagnosis of a substance use disorder is based on a pathological pattern of behaviors related to the use of the substances.
[ 2025 c 58 s 5155. Prior: 2021 c 287 s 4; (2021 c 287 s 3 expired July 1, 2022); (2021 c 287 s 2 expired January 1, 2022); prior: 2020 c 312 s 732; 2020 c 80 s 53; 2016 c 209 s 407; 2011 c 89 s 15; 2003 c 283 s 2.]
Notes:
Effective date—2025 c 58 ss 5058-5170: See note following RCW 7.68.030.
Explanatory note—2025 c 58: See note following RCW 1.16.050.
Effective date—2021 c 287 s 4: "Section 4 of this act takes effect July 1, 2022." [ 2021 c 287 s 25.]
Effective date—2021 c 287 s 3: "Section 3 of this act takes effect January 1, 2022." [ 2021 c 287 s 23.]
Expiration date—2021 c 287 s 3: "Section 3 of this act expires July 1, 2022." [ 2021 c 287 s 24.]
Expiration date—2021 c 287 s 2: "Section 2 of this act expires January 1, 2022." [ 2021 c 287 s 22.]
Effective dates—2020 c 312: See note following RCW 11.130.915.
Effective date—2020 c 80 ss 12-59: See note following RCW 7.68.030.
Intent—2020 c 80: See note following RCW 18.71A.010.
Short title—Application—Uniformity—Federal law application—Federal electronic signatures in global and national commerce act—Application—Dates—Effective date—2016 c 209: See RCW 11.125.010 and 11.125.900 through 11.125.903.
Effective date—2011 c 89: See note following RCW 18.320.005.
Findings—2011 c 89: See RCW 18.320.005.

catchline: Definitions. (Effective until June 30, 2027.)


title: RCW 71.32.030

text:
(1) The definition of informed consent is to be construed to be consistent with that term as it is used in chapter 7.70 RCW.
(2) The definitions of mental disorder, behavioral health disorder, mental health professional, and professional person are to be construed to be consistent with those terms as they are defined in RCW 71.05.020.
[ 2021 c 287 s 5; 2003 c 283 s 3.]

catchline: Construction of definitions.


title: RCW 71.32.040

text:
For the purposes of this chapter, an adult is presumed to have capacity. A person who is at least 13 years of age but under the age of majority is considered to have capacity for the purpose of executing a mental health advance directive if the person is able to demonstrate that they are capable of making informed decisions related to behavioral health care.
[ 2021 c 287 s 6; 2003 c 283 s 4.]

catchline: Presumption of capacity.


title: RCW 71.32.050

text:
(1) A person with capacity may execute a mental health advance directive.
(2) A directive executed in accordance with this chapter is presumed to be valid. The inability to honor one or more provisions of a directive does not affect the validity of the remaining provisions.
(3) A directive may include any provision relating to behavioral health treatment or the care of the principal or the principal's personal affairs. Without limitation, a directive may include:
(a) The principal's preferences and instructions for behavioral health treatment;
(b) Consent to specific types of behavioral health treatment;
(c) Refusal to consent to specific types of behavioral health treatment;
(d) Consent to admission to and retention in a facility for behavioral health treatment for up to 14 days;
(e) Descriptions of situations that may cause the principal to experience a behavioral health crisis;
(f) Suggested alternative responses that may supplement or be in lieu of direct behavioral health treatment, such as treatment approaches from other providers;
(g) Appointment of an agent pursuant to chapter 11.125 RCW to make behavioral health treatment decisions on the principal's behalf, including authorizing the agent to provide consent on the principal's behalf to voluntary admission to inpatient behavioral health treatment; and
(h) The principal's nomination of a guardian or limited guardian as provided in RCW 11.125.080 for consideration by the court if guardianship proceedings are commenced.
(4) A directive may be combined with or be independent of a nomination of a guardian or other durable power of attorney under chapter 11.125 RCW, so long as the processes for each are executed in accordance with its own statutes.
[ 2021 c 287 s 7; 2016 c 209 s 408; 2003 c 283 s 5.]
Notes:
Short title—Application—Uniformity—Federal law application—Federal electronic signatures in global and national commerce act—Application—Dates—Effective date—2016 c 209: See RCW 11.125.010 and 11.125.900 through 11.125.903.

catchline: Execution of directive—Scope.


title: RCW 71.32.060

text:
(1) A directive shall:
(a) Be in writing;
(b) Contain language that clearly indicates that the principal intends to create a directive;
(c) Be dated and signed by the principal or at the principal's direction in the principal's presence if the principal is unable to sign;
(d) Designate whether the principal wishes to be able to revoke the directive during any period of incapacity or wishes to be unable to revoke the directive during any period of incapacity; and
(e) Have the signature acknowledged before a notary public or other individual authorized by law to take acknowledgments, or be witnessed in writing by at least two adults, each of whom shall declare that he or she personally knows the principal, was present when the principal dated and signed the directive, and that the principal did not appear to be incapacitated or acting under fraud, undue influence, or duress.
(2) A directive that includes the appointment of an agent pursuant to a power of attorney under chapter 11.125 RCW shall contain the words "This power of attorney shall not be affected by the incapacity of the principal," or "This power of attorney shall become effective upon the incapacity of the principal," or similar words showing the principal's intent that the authority conferred shall be exercisable notwithstanding the principal's incapacity.
(3) A directive is valid upon execution, but all or part of the directive may take effect at a later time as designated by the principal in the directive.
(4) A directive may:
(a) Be revoked, in whole or in part, pursuant to the provisions of RCW 71.32.080; or
(b) Expire under its own terms.
[ 2021 c 287 s 8; 2016 c 209 s 409; 2003 c 283 s 6.]
Notes:
Short title—Application—Uniformity—Federal law application—Federal electronic signatures in global and national commerce act—Application—Dates—Effective date—2016 c 209: See RCW 11.125.010 and 11.125.900 through 11.125.903.

catchline: Execution of directive—Elements—Effective date—Expiration.


title: RCW 71.32.070

text:
A directive may not:
(1) Create an entitlement to behavioral health or medical treatment or supersede a determination of medical necessity;
(2) Obligate any health care provider, professional person, or health care facility to pay the costs associated with the treatment requested;
(3) Obligate any health care provider, professional person, or health care facility to be responsible for the nontreatment personal care of the principal or the principal's personal affairs outside the scope of services the facility normally provides;
(4) Replace or supersede the provisions of any will or testamentary document or supersede the provisions of intestate succession;
(5) Be revoked by an incapacitated principal unless that principal selected the option to permit revocation while incapacitated at the time his or her directive was executed; or
(6) Be used as the authority for inpatient admission for more than 14 days in any 21 day period.
[ 2021 c 287 s 9; 2003 c 283 s 7.]

catchline: Prohibited elements.


title: RCW 71.32.080

text:
(1)(a) A principal with capacity may, by written statement by the principal or at the principal's direction in the principal's presence, revoke a directive in whole or in part.
(b) An incapacitated principal may revoke a directive only if he or she elected at the time of executing the directive to be able to revoke when incapacitated.
(2) The revocation need not follow any specific form so long as it is written and the intent of the principal can be discerned. In the case of a directive that is stored in the health care declarations registry created by RCW 70.122.130, the revocation may be by an online method established by the department of health. Failure to use the online method of revocation for a directive that is stored in the registry does not invalidate a revocation that is made by another method described under this section.
(3) The principal shall provide a copy of his or her written statement of revocation to his or her agent, if any, and to each health care provider, professional person, or health care facility that received a copy of the directive from the principal.
(4) The written statement of revocation is effective:
(a) As to a health care provider, professional person, or health care facility, upon receipt. The professional person, health care provider, or health care facility, or persons acting under their direction shall make the statement of revocation part of the principal's medical record; and
(b) As to the principal's agent, upon receipt. The principal's agent shall notify the principal's health care provider, professional person, or health care facility of the revocation and provide them with a copy of the written statement of revocation.
(5) A directive also may:
(a) Be revoked, in whole or in part, expressly or to the extent of any inconsistency, by a subsequent directive; or
(b) Be superseded or revoked by a court order, including any order entered in a criminal matter. A directive may be superseded by a court order regardless of whether the order contains an explicit reference to the directive. To the extent a directive is not in conflict with a court order, the directive remains effective, subject to the provisions of RCW 71.32.150. A directive shall not be interpreted in a manner that interferes with: (i) Incarceration or detention by the department of corrections, in a city or county jail, or by the department of social and health services; or (ii) treatment of a principal who is subject to involuntary treatment pursuant to chapter 10.77, 71.05, 71.09, or 71.34 RCW.
(6) A directive that would have otherwise expired but is effective because the principal is incapacitated remains effective until the principal is no longer incapacitated unless the principal has elected to be able to revoke while incapacitated and has revoked the directive.
(7) When a principal with capacity consents to treatment that differs from, or refuses treatment consented to in, the provisions of his or her directive, the consent or refusal constitutes a waiver of that provision and does not constitute a revocation of the provision or directive unless the principal also revokes the directive or provision.
[ 2016 sp.s. c 29 s 423; 2006 c 108 s 5; 2003 c 283 s 8.]
Notes:
Effective dates—2016 sp.s. c 29: See note following RCW 71.05.760.
Short title—Right of action—2016 sp.s. c 29: See notes following RCW 71.05.010.
Finding—Intent—2006 c 108: See note following RCW 70.122.130.

catchline: Revocation—Waiver.


title: RCW 71.32.090

text:
A witness may not be any of the following:
(1) A person designated to make health care decisions on the principal's behalf;
(2) A health care provider or professional person directly involved with the provision of care to the principal at the time the directive is executed;
(3) An owner, operator, employee, or relative of an owner or operator of a health care facility or long-term care facility in which the principal is a patient or resident;
(4) A person who is related by blood, marriage, or adoption to the person or with whom the principal has a dating relationship, as defined in RCW 7.105.010;
(5) A person who is declared to be an incapacitated person; or
(6) A person who would benefit financially if the principal making the directive undergoes mental health treatment.
[ 2021 c 215 s 157; 2003 c 283 s 9.]
Notes:
Effective date—2022 c 268; 2021 c 215: See note following RCW 7.105.900.

catchline: Witnesses.


title: RCW 71.32.100

text:
(1) If a directive authorizes the appointment of an agent, the provisions of chapter 11.125 RCW and RCW 7.70.065 shall apply unless otherwise stated in this chapter.
(2) The principal who appoints an agent must notify the agent in writing of the appointment.
(3) An agent must act in good faith.
(4) An agent may make decisions on behalf of the principal. Unless the principal has revoked the directive, the decisions must be consistent with the instructions and preferences the principal has expressed in the directive, or if not expressed, as otherwise known to the agent. If the principal's instructions or preferences are not known, the agent shall make a decision he or she determines is in the best interest of the principal.
(5) A person authorized to act as an agent during periods when the principal is incapacitated may act as the principal's personal representative pursuant to the health insurance portability and accountability act, sections 1171 through 1179 of the social security act, 42 U.S.C. Sec. 1320d, as amended, and applicable regulations, to obtain access to the principal's health care information and communicate with the principal's health care provider. This subsection shall be construed to be consistent with chapters 70.02, 70.24, 71.05, and 71.34 RCW, and with federal law regarding health care information.
(6) Unless otherwise provided in the appointment and agreed to in writing by the agent, the agent is not, as a result of acting in the capacity of agent, personally liable for the cost of treatment provided to the principal.
(7) An agent may resign or withdraw at any time by giving written notice to the principal. The agent must also give written notice to any health care provider, professional person, or health care facility providing treatment to the principal. The resignation or withdrawal is effective upon receipt unless otherwise specified in the resignation or withdrawal.
(8) If the directive gives the agent authority to act while the principal has capacity, the decisions of the principal supersede those of the agent at any time the principal has capacity.
(9) An agent's authority terminates when an action is filed for the dissolution or annulment of the agent's marriage to the principal or for their legal separation, or an action is filed for dissolution or annulment of the agent's state registered domestic partnership with the principal or for their legal separation.
(10) Unless otherwise provided in the durable power of attorney, the principal may revoke the agent's appointment as provided under other state law.
[ 2021 c 287 s 10; 2016 c 209 s 410; 2003 c 283 s 10.]
Notes:
Short title—Application—Uniformity—Federal law application—Federal electronic signatures in global and national commerce act—Application—Dates—Effective date—2016 c 209: See RCW 11.125.010 and 11.125.900 through 11.125.903.

catchline: Appointment of agent.


title: RCW 71.32.110

text:
(1) For the purposes of this chapter, a principal, agent, professional person, or health care provider may seek a determination whether the principal is incapacitated or has regained capacity.
(2)(a) For the purposes of this chapter, no adult may be declared an incapacitated person except by:
(i) A court, if the request is made by the principal or the principal's agent;
(ii) One mental health professional or substance use disorder professional and one health care provider; or
(iii) Two health care providers.
(b) One of the persons making the determination under (a)(ii) or (iii) of this subsection must be a psychiatrist, physician assistant working with a psychiatrist who is acting as a participating physician as defined in RCW 18.71A.010, psychologist, or a psychiatric advanced registered nurse practitioner.
(3) When a professional person or health care provider requests a capacity determination, he or she shall promptly inform the principal that:
(a) A request for capacity determination has been made; and
(b) The principal may request that the determination be made by a court.
(4) At least one mental health professional, substance use disorder professional, or health care provider must personally examine the principal prior to making a capacity determination.
(5)(a) When a court makes a determination whether a principal has capacity, the court shall, at a minimum, be informed by the testimony of one mental health professional or substance use disorder professional familiar with the principal and shall, except for good cause, give the principal an opportunity to appear in court prior to the court making its determination.
(b) To the extent that local court rules permit, any party or witness may testify telephonically.
(6) When a court has made a determination regarding a principal's capacity and there is a subsequent change in the principal's condition, subsequent determinations whether the principal is incapacitated may be made in accordance with any of the provisions of subsection (2) of this section.
[ 2024 c 62 s 23; 2021 c 287 s 11; 2016 c 155 s 13; 2003 c 283 s 11.]
Notes:
Effective date—2024 c 62 ss 1-8, 10-18, 20-26, 28, and 30-32: See note following RCW 18.71A.010.
Intent—2024 c 62: See note following RCW 18.71A.020.
PDF
RCW 71.32.110
Determination of capacity. (Effective June 30, 2027.)
(1) For the purposes of this chapter, a principal, agent, professional person, or health care provider may seek a determination whether the principal is incapacitated or has regained capacity.
(2)(a) For the purposes of this chapter, no adult may be declared an incapacitated person except by:
(i) A court, if the request is made by the principal or the principal's agent;
(ii) One mental health professional or substance use disorder professional and one health care provider; or
(iii) Two health care providers.
(b) One of the persons making the determination under (a)(ii) or (iii) of this subsection must be a psychiatrist, physician assistant working with a psychiatrist who is acting as a participating physician as defined in RCW 18.71A.010, psychologist, or a psychiatric advanced practice registered nurse.
(3) When a professional person or health care provider requests a capacity determination, he or she shall promptly inform the principal that:
(a) A request for capacity determination has been made; and
(b) The principal may request that the determination be made by a court.
(4) At least one mental health professional, substance use disorder professional, or health care provider must personally examine the principal prior to making a capacity determination.
(5)(a) When a court makes a determination whether a principal has capacity, the court shall, at a minimum, be informed by the testimony of one mental health professional or substance use disorder professional familiar with the principal and shall, except for good cause, give the principal an opportunity to appear in court prior to the court making its determination.
(b) To the extent that local court rules permit, any party or witness may testify telephonically.
(6) When a court has made a determination regarding a principal's capacity and there is a subsequent change in the principal's condition, subsequent determinations whether the principal is incapacitated may be made in accordance with any of the provisions of subsection (2) of this section.
[ 2025 c 58 s 5156; 2024 c 62 s 23; 2021 c 287 s 11; 2016 c 155 s 13; 2003 c 283 s 11.]
Notes:
Effective date—2025 c 58 ss 5058-5170: See note following RCW 7.68.030.
Explanatory note—2025 c 58: See note following RCW 1.16.050.
Effective date—2024 c 62 ss 1-8, 10-18, 20-26, 28, and 30-32: See note following RCW 18.71A.010.
Intent—2024 c 62: See note following RCW 18.71A.020.

catchline: Determination of capacity. (Effective until June 30, 2027.)


title: RCW 71.32.120

text:
A principal may bring an action to contest the validity of his or her directive. If an action under this section is commenced while an action to determine the principal's capacity is pending, the court shall consolidate the actions and decide the issues simultaneously.
[ 2003 c 283 s 12.]

catchline: Action to contest directive.


title: RCW 71.32.130

text:
(1) An initial determination of capacity must be completed within 48 hours of a request made by a person authorized in RCW 71.32.110. During the period between the request for an initial determination of the principal's capacity and completion of that determination, the principal may not be treated unless he or she consents at the time or treatment is otherwise authorized by state or federal law.
(2)(a)(i) When an incapacitated principal is admitted to inpatient treatment pursuant to the provisions of his or her directive, his or her capacity must be reevaluated within 120 hours or when there has been a change in the principal's condition that indicates that he or she appears to have regained capacity, whichever occurs first.
(ii) When an incapacitated principal has been admitted to and remains in inpatient treatment for more than 120 hours pursuant to the provisions of his or her directive, the principal's capacity must be reevaluated when there has been a change in his or her condition that indicates that he or she appears to have regained capacity.
(iii) When a principal who is being treated on an inpatient basis and has been determined to be incapacitated requests, or his or her agent requests, a redetermination of the principal's capacity the redetermination must be made within 120 hours.
(b) When a principal who has been determined to be incapacitated is being treated on an outpatient basis and there is a request for a redetermination of his or her capacity, the redetermination must be made within five days of the first request following a determination.
(3)(a) When a principal who has appointed an agent for behavioral health treatment decisions requests a determination or redetermination of capacity, the agent must make reasonable efforts to obtain the determination or redetermination.
(b) When a principal who does not have an agent for behavioral health treatment decisions is being treated in an inpatient facility and requests a determination or redetermination of capacity, the mental health professional or health care provider must complete the determination or, if the principal is seeking a determination from a court, must make reasonable efforts to notify the person authorized to make decisions for the principal under RCW 7.70.065 of the principal's request.
(c) When a principal who does not have an agent for behavioral health treatment decisions is being treated on an outpatient basis, the person requesting a capacity determination must arrange for the determination.
(4) If no determination has been made within the time frames established in subsection (1) or (2) of this section, the principal shall be considered to have capacity.
(5) When an incapacitated principal is being treated pursuant to his or her directive, a request for a redetermination of capacity does not prevent treatment.
[ 2021 c 287 s 12; 2003 c 283 s 13.]

catchline: Determination of capacity—Reevaluations of capacity.


title: RCW 71.32.140

text:
(1) A principal who:
(a) Chose not to be able to revoke his or her directive during any period of incapacity;
(b) Consented to voluntary admission to inpatient behavioral health treatment, or authorized an agent to consent on the principal's behalf; and
(c) At the time of admission to inpatient treatment, refuses to be admitted, may only be admitted into inpatient behavioral health treatment under subsection (2) of this section.
(2) A principal may only be admitted to inpatient behavioral health treatment under his or her directive if, prior to admission, a member of the treating facility's professional staff who is a physician, physician assistant, or psychiatric advanced registered nurse practitioner:
(a) Evaluates the principal's mental condition, including a review of reasonably available psychiatric and psychological history, diagnosis, and treatment needs, and determines, in conjunction with another health care provider, mental health professional, or substance use disorder professional, that the principal is incapacitated;
(b) Obtains the informed consent of the agent, if any, designated in the directive;
(c) Makes a written determination that the principal needs an inpatient evaluation or is in need of inpatient treatment and that the evaluation or treatment cannot be accomplished in a less restrictive setting; and
(d) Documents in the principal's medical record a summary of the physician's, physician assistant's, or psychiatric advanced registered nurse practitioner's findings and recommendations for treatment or evaluation.
(3) In the event the admitting physician is not a psychiatrist, the admitting physician assistant is not working with a psychiatrist who is acting as a participating physician as defined in RCW 18.71A.010, or the *advanced registered nurse practitioner is not a psychiatric advanced registered nurse practitioner, the principal shall receive a complete behavioral health assessment by a mental health professional or substance use disorder professional within 24 hours of admission to determine the continued need for inpatient evaluation or treatment.
(4)(a) If it is determined that the principal has capacity, then the principal may only be admitted to, or remain in, inpatient treatment if he or she consents at the time, is admitted for family-initiated treatment under chapter 71.34 RCW, or is detained under the involuntary treatment provisions of chapter 71.05 or 71.34 RCW.
(b) If a principal who is determined by two health care providers or one mental health professional or substance use disorder professional and one health care provider to be incapacitated continues to refuse inpatient treatment, the principal may immediately seek injunctive relief for release from the facility.
(5) If, at the end of the period of time that the principal or the principal's agent, if any, has consented to voluntary inpatient treatment, but no more than 14 days after admission, the principal has not regained capacity or has regained capacity but refuses to consent to remain for additional treatment, the principal must be released during reasonable daylight hours, unless detained under chapter 71.05 or 71.34 RCW.
(6)(a) Except as provided in (b) of this subsection, any principal who is voluntarily admitted to inpatient behavioral health treatment under this chapter shall have all the rights provided to individuals who are voluntarily admitted to inpatient treatment under chapter 71.05, 71.34, or 72.23 RCW.
(b) Notwithstanding RCW 71.05.050 regarding consent to inpatient treatment for a specified length of time, the choices an incapacitated principal expressed in his or her directive shall control, provided, however, that a principal who takes action demonstrating a desire to be discharged, in addition to making statements requesting to be discharged, shall be discharged, and no principal shall be restrained in any way in order to prevent his or her discharge. Nothing in this subsection shall be construed to prevent detention and evaluation for civil commitment under chapter 71.05 RCW.
(7) Consent to inpatient admission in a directive is effective only while the professional person, health care provider, and health care facility are in substantial compliance with the material provisions of the directive related to inpatient treatment.
[ 2024 c 62 s 24; 2021 c 287 s 13. Prior: 2016 sp.s. c 29 s 424; 2016 c 155 s 14; 2009 c 217 s 12; 2004 c 39 s 2; 2003 c 283 s 14.]
Notes:
*Reviser's note: The term "advanced registered nurse practitioner" was changed to "advanced practice registered nurse" by 2024 c 239 s 1, effective June 30, 2027.
Effective date—2024 c 62 ss 1-8, 10-18, 20-26, 28, and 30-32: See note following RCW 18.71A.010.
Intent—2024 c 62: See note following RCW 18.71A.020.
Effective dates—2016 sp.s. c 29: See note following RCW 71.05.760.
Short title—Right of action—2016 sp.s. c 29: See notes following RCW 71.05.010.
Finding—Intent—2004 c 39: "Questions have been raised about the intent of the legislature in cross-referencing RCW 71.05.050 without further clarification in RCW 71.32.140. The legislature finds that because RCW 71.05.050 pertains to a variety of rights as well as the procedures for detaining a voluntary patient for evaluation for civil commitment, and the legislature intended only to address the right of release upon request, there is ambiguity as to whether an incapacitated person admitted pursuant to his or her mental health advance directive and seeking release can be held for evaluation for civil commitment under chapter 71.05 RCW. The legislature therefore intends to clarify the ambiguity without making any change to its intended policy as laid out in chapter 71.32 RCW." [ 2004 c 39 s 1.]
PDF
RCW 71.32.140
Refusal of admission to inpatient treatment—Effect of directive. (Effective June 30, 2027.)
(1) A principal who:
(a) Chose not to be able to revoke his or her directive during any period of incapacity;
(b) Consented to voluntary admission to inpatient behavioral health treatment, or authorized an agent to consent on the principal's behalf; and
(c) At the time of admission to inpatient treatment, refuses to be admitted, may only be admitted into inpatient behavioral health treatment under subsection (2) of this section.
(2) A principal may only be admitted to inpatient behavioral health treatment under his or her directive if, prior to admission, a member of the treating facility's professional staff who is a physician, physician assistant, or psychiatric advanced practice registered nurse:
(a) Evaluates the principal's mental condition, including a review of reasonably available psychiatric and psychological history, diagnosis, and treatment needs, and determines, in conjunction with another health care provider, mental health professional, or substance use disorder professional, that the principal is incapacitated;
(b) Obtains the informed consent of the agent, if any, designated in the directive;
(c) Makes a written determination that the principal needs an inpatient evaluation or is in need of inpatient treatment and that the evaluation or treatment cannot be accomplished in a less restrictive setting; and
(d) Documents in the principal's medical record a summary of the physician's, physician assistant's, or psychiatric advanced practice registered nurse's findings and recommendations for treatment or evaluation.
(3) In the event the admitting physician is not a psychiatrist, the admitting physician assistant is not working with a psychiatrist who is acting as a participating physician as defined in RCW 18.71A.010, or the advanced practice registered nurse is not a psychiatric advanced practice registered nurse, the principal shall receive a complete behavioral health assessment by a mental health professional or substance use disorder professional within 24 hours of admission to determine the continued need for inpatient evaluation or treatment.
(4)(a) If it is determined that the principal has capacity, then the principal may only be admitted to, or remain in, inpatient treatment if he or she consents at the time, is admitted for family-initiated treatment under chapter 71.34 RCW, or is detained under the involuntary treatment provisions of chapter 71.05 or 71.34 RCW.
(b) If a principal who is determined by two health care providers or one mental health professional or substance use disorder professional and one health care provider to be incapacitated continues to refuse inpatient treatment, the principal may immediately seek injunctive relief for release from the facility.
(5) If, at the end of the period of time that the principal or the principal's agent, if any, has consented to voluntary inpatient treatment, but no more than 14 days after admission, the principal has not regained capacity or has regained capacity but refuses to consent to remain for additional treatment, the principal must be released during reasonable daylight hours, unless detained under chapter 71.05 or 71.34 RCW.
(6)(a) Except as provided in (b) of this subsection, any principal who is voluntarily admitted to inpatient behavioral health treatment under this chapter shall have all the rights provided to individuals who are voluntarily admitted to inpatient treatment under chapter 71.05, 71.34, or 72.23 RCW.
(b) Notwithstanding RCW 71.05.050 regarding consent to inpatient treatment for a specified length of time, the choices an incapacitated principal expressed in his or her directive shall control, provided, however, that a principal who takes action demonstrating a desire to be discharged, in addition to making statements requesting to be discharged, shall be discharged, and no principal shall be restrained in any way in order to prevent his or her discharge. Nothing in this subsection shall be construed to prevent detention and evaluation for civil commitment under chapter 71.05 RCW.
(7) Consent to inpatient admission in a directive is effective only while the professional person, health care provider, and health care facility are in substantial compliance with the material provisions of the directive related to inpatient treatment.
[ 2025 c 58 s 5157; 2024 c 62 s 24; 2021 c 287 s 13. Prior: 2016 sp.s. c 29 s 424; 2016 c 155 s 14; 2009 c 217 s 12; 2004 c 39 s 2; 2003 c 283 s 14.]
Notes:
Effective date—2025 c 58 ss 5058-5170: See note following RCW 7.68.030.
Explanatory note—2025 c 58: See note following RCW 1.16.050.
Effective date—2024 c 62 ss 1-8, 10-18, 20-26, 28, and 30-32: See note following RCW 18.71A.010.
Intent—2024 c 62: See note following RCW 18.71A.020.
Effective dates—2016 sp.s. c 29: See note following RCW 71.05.760.
Short title—Right of action—2016 sp.s. c 29: See notes following RCW 71.05.010.
Finding—Intent—2004 c 39: "Questions have been raised about the intent of the legislature in cross-referencing RCW 71.05.050 without further clarification in RCW 71.32.140. The legislature finds that because RCW 71.05.050 pertains to a variety of rights as well as the procedures for detaining a voluntary patient for evaluation for civil commitment, and the legislature intended only to address the right of release upon request, there is ambiguity as to whether an incapacitated person admitted pursuant to his or her mental health advance directive and seeking release can be held for evaluation for civil commitment under chapter 71.05 RCW. The legislature therefore intends to clarify the ambiguity without making any change to its intended policy as laid out in chapter 71.32 RCW." [ 2004 c 39 s 1.]

catchline: Refusal of admission to inpatient treatment—Effect of directive. (Effective until June 30, 2027.)


title: RCW 71.32.150

text:
(1) Upon receiving a directive, a health care provider, professional person, or health care facility providing treatment to the principal, or persons acting under the direction of the health care provider, professional person, or health care facility, shall make the directive a part of the principal's medical record and shall be deemed to have actual knowledge of the directive's contents.
(2) When acting under authority of a directive, a health care provider, professional person, or health care facility shall act in accordance with the provisions of the directive to the fullest extent possible, unless in the determination of the health care provider, professional person, or health care facility:
(a) Compliance with the provision would violate the accepted standard of care established in RCW 7.70.040;
(b) The requested treatment is not available;
(c) Compliance with the provision would violate applicable law; or
(d) It is an emergency situation and compliance would endanger any person's life or health.
(3)(a) In the case of a principal committed or detained under the involuntary treatment provisions of chapter 10.77, 71.05, 71.09, or 71.34 RCW, those provisions of a principal's directive that, in the determination of the health care provider, professional person, or health care facility, are inconsistent with the purpose of the commitment or with any order of the court relating to the commitment are invalid during the commitment.
(b) Remaining provisions of a principal's directive are advisory while the principal is committed or detained.
The treatment provider is encouraged to follow the remaining provisions of the directive, except as provided in (a) of this subsection or subsection (2) of this section.
(4) In the case of a principal who is incarcerated or committed in a state or local correctional facility, provisions of the principal's directive that are inconsistent with reasonable penological objectives or administrative hearings regarding involuntary medication are invalid during the period of incarceration or commitment. In addition, treatment may be given despite refusal of the principal or the provisions of the directive: (a) For any reason under subsection (2) of this section; or (b) if, without the benefit of the specific treatment measure, there is a significant possibility that the person will harm self or others before an improvement of the person's condition occurs.
(5)(a) If the health care provider, professional person, or health care facility is, at the time of receiving the directive, unable or unwilling to comply with any part or parts of the directive for any reason, the health care provider, professional person, or health care facility shall promptly notify the principal and, if applicable, his or her agent and shall document the reason in the principal's medical record.
(b) If the health care provider, professional person, or health care facility is acting under authority of a directive and is unable to comply with any part or parts of the directive for the reasons listed in subsection (2) or (3) of this section, the health care provider, professional person, or health care facility shall promptly notify the principal and if applicable, his or her agent, and shall document the reason in the principal's medical record.
(6) In the event that one or more parts of the directive are not followed because of one or more of the reasons set forth in subsection (2) or (4) of this section, all other parts of the directive shall be followed.
(7) If no provider-patient relationship has previously been established, nothing in this chapter requires the establishment of a provider-patient relationship.
[ 2016 sp.s. c 29 s 425; 2003 c 283 s 15.]
Notes:
Effective dates—2016 sp.s. c 29: See note following RCW 71.05.760.
Short title—Right of action—2016 sp.s. c 29: See notes following RCW 71.05.010.

catchline: Compliance with directive—Conditions for noncompliance.


title: RCW 71.32.160

text:
Where a principal consents in a directive to electroconvulsive therapy, the health care provider, professional person, or health care facility, or persons acting under the direction of the health care provider, professional person, or health care facility, shall document the therapy and the reason it was used in the principal's medical record.
[ 2003 c 283 s 16.]

catchline: Electroconvulsive therapy.


title: RCW 71.32.170

text:
(1) For the purposes of this section, "provider" means a private or public agency, government entity, health care provider, professional person, health care facility, or person acting under the direction of a health care provider or professional person, health care facility, or long-term care facility.
(2) A provider is not subject to civil liability or sanctions for unprofessional conduct under the uniform disciplinary act, chapter 18.130 RCW, when in good faith and without negligence:
(a) The provider provides treatment to a principal in the absence of actual knowledge of the existence of a directive, or provides treatment pursuant to a directive in the absence of actual knowledge of the revocation of the directive;
(b) A health care provider or mental health professional determines that the principal is or is not incapacitated for the purpose of deciding whether to proceed according to a directive, and acts upon that determination;
(c) The provider administers or does not administer behavioral health treatment according to the principal's directive in good faith reliance upon the validity of the directive and the directive is subsequently found to be invalid;
(d) The provider does not provide treatment according to the directive for one of the reasons authorized under RCW 71.32.150; or
(e) The provider provides treatment according to the principal's directive.
[ 2021 c 287 s 14; 2003 c 283 s 17.]


title: RCW 71.32.180

text:
(1) Where an incapacitated principal has executed more than one valid directive and has not revoked any of the directives:
(a) The directive most recently created shall be treated as the principal's behavioral health treatment preferences and instructions as to any inconsistent or conflicting provisions, unless provided otherwise in either document.
(b) Where a directive executed under this chapter is inconsistent with a directive executed under any other chapter, the most recently created directive controls as to the inconsistent provisions.
(2) Where an incapacitated principal has appointed more than one agent under chapter 11.125 RCW with authority to make behavioral health treatment decisions, RCW 11.125.400 controls.
(3) The treatment provider shall inquire of a principal whether the principal is subject to any court orders that would affect the implementation of his or her directive.
[ 2021 c 287 s 15; 2016 c 209 s 411; 2003 c 283 s 18.]
Notes:
Short title—Application—Uniformity—Federal law application—Federal electronic signatures in global and national commerce act—Application—Dates—Effective date—2016 c 209: See RCW 11.125.010 and 11.125.900 through 11.125.903.

catchline: Multiple directives, agents—Effect—Disclosure of court orders.


title: RCW 71.32.190

text:
(1) Directives validly executed before July 27, 2003, shall be given full force and effect until revoked, superseded, or expired.
(2) A directive validly executed in another political jurisdiction is valid to the extent permitted by Washington state law.
[ 2003 c 283 s 19.]


title: RCW 71.32.200

text:
Any person with reasonable cause to believe that a directive has been created or revoked under circumstances amounting to fraud, duress, or undue influence may petition the court for appointment of a guardian for the person or to review the actions of the agent or person alleged to be involved in improper conduct under RCW 11.125.160 or chapter 74.34 RCW.
[ 2021 c 215 s 158; 2016 c 209 s 412; 2003 c 283 s 20.]
Notes:
Effective date—2022 c 268; 2021 c 215: See note following RCW 7.105.900.
Short title—Application—Uniformity—Federal law application—Federal electronic signatures in global and national commerce act—Application—Dates—Effective date—2016 c 209: See RCW 11.125.010 and 11.125.900 through 11.125.903.

catchline: Fraud, duress, undue influence—Appointment of guardian.


title: RCW 71.32.210

text:
The fact that a person has executed a directive does not constitute an indication of behavioral health disorder or that the person is not capable of providing informed consent.
[ 2021 c 287 s 16; 2003 c 283 s 21.]

catchline: Execution of directive not evidence of behavioral health disorder or lack of capacity.


title: RCW 71.32.220

text:
A person shall not be required to execute or to refrain from executing a directive, nor shall the existence of a directive be used as a criterion for insurance, as a condition for receiving behavioral or physical health services, or as a condition of admission to or discharge from a health care facility or long-term care facility.
[ 2021 c 287 s 17; 2003 c 283 s 22.]

catchline: Requiring directive prohibited.


title: RCW 71.32.230

text:
No person or health care facility may use or threaten abuse, neglect, financial exploitation, or abandonment of the principal, as those terms are defined in RCW 74.34.020, to carry out the directive.
[ 2003 c 283 s 23.]

catchline: Coercion, threats prohibited.


title: RCW 71.32.240

text:
A directive does not limit any authority otherwise provided in Title 10, 70, or 71 RCW, or any other applicable state or federal laws to detain a person, take a person into custody, or to admit, retain, or treat a person in a health care facility.
[ 2003 c 283 s 24.]

catchline: Other authority not limited.


title: RCW 71.32.250

text:
(1) If a principal who is a resident of a long-term care facility is admitted to inpatient behavioral health treatment pursuant to his or her directive, the principal shall be allowed to be readmitted to the same long-term care facility as if his or her inpatient admission had been for a physical condition on the same basis that the principal would be readmitted under state or federal statute or rule when:
(a) The treating facility's professional staff determine that inpatient behavioral health treatment is no longer medically necessary for the resident. The determination shall be made in writing by a psychiatrist, physician assistant working with a psychiatrist who is acting as a participating physician as defined in RCW 18.71A.010, or a psychiatric advanced registered nurse practitioner, or (i) one physician and a mental health professional or substance use disorder professional; (ii) one physician assistant and a mental health professional or substance use disorder professional; or (iii) one psychiatric advanced registered nurse practitioner and a mental health professional or substance use disorder professional; or
(b) The person's consent to admission in his or her directive has expired.
(2)(a) If the long-term care facility does not have a bed available at the time of discharge, the treating facility may discharge the resident, in consultation with the resident and agent if any, and in accordance with a medically appropriate discharge plan, to another long-term care facility.
(b) This section shall apply to inpatient behavioral health treatment admission of long-term care facility residents, regardless of whether the admission is directly from a facility, hospital emergency room, or other location.
(c) This section does not restrict the right of the resident to an earlier release from the inpatient treatment facility. This section does not restrict the right of a long-term care facility to initiate transfer or discharge of a resident who is readmitted pursuant to this section, provided that the facility has complied with the laws governing the transfer or discharge of a resident.
(3) The joint legislative audit and review committee shall conduct an evaluation of the operation and impact of this section. The committee shall report its findings to the appropriate committees of the legislature by December 1, 2004.
[ 2024 c 62 s 25; 2021 c 287 s 18; 2016 c 155 s 15; 2009 c 217 s 13; 2003 c 283 s 25.]
Notes:
Effective date—2024 c 62 ss 1-8, 10-18, 20-26, 28, and 30-32: See note following RCW 18.71A.010.
Intent—2024 c 62: See note following RCW 18.71A.020.
PDF
RCW 71.32.250
Long-term care facility residents—Readmission after inpatient behavioral health treatment—Evaluation, report to legislature. (Effective June 30, 2027.)
(1) If a principal who is a resident of a long-term care facility is admitted to inpatient behavioral health treatment pursuant to his or her directive, the principal shall be allowed to be readmitted to the same long-term care facility as if his or her inpatient admission had been for a physical condition on the same basis that the principal would be readmitted under state or federal statute or rule when:
(a) The treating facility's professional staff determine that inpatient behavioral health treatment is no longer medically necessary for the resident. The determination shall be made in writing by a psychiatrist, physician assistant working with a psychiatrist who is acting as a participating physician as defined in RCW 18.71A.010, or a psychiatric advanced practice registered nurse, or (i) one physician and a mental health professional or substance use disorder professional; (ii) one physician assistant and a mental health professional or substance use disorder professional; or (iii) one psychiatric advanced practice registered nurse and a mental health professional or substance use disorder professional; or
(b) The person's consent to admission in his or her directive has expired.
(2)(a) If the long-term care facility does not have a bed available at the time of discharge, the treating facility may discharge the resident, in consultation with the resident and agent if any, and in accordance with a medically appropriate discharge plan, to another long-term care facility.
(b) This section shall apply to inpatient behavioral health treatment admission of long-term care facility residents, regardless of whether the admission is directly from a facility, hospital emergency room, or other location.
(c) This section does not restrict the right of the resident to an earlier release from the inpatient treatment facility. This section does not restrict the right of a long-term care facility to initiate transfer or discharge of a resident who is readmitted pursuant to this section, provided that the facility has complied with the laws governing the transfer or discharge of a resident.
(3) The joint legislative audit and review committee shall conduct an evaluation of the operation and impact of this section. The committee shall report its findings to the appropriate committees of the legislature by December 1, 2004.
[ 2025 c 58 s 5158; 2024 c 62 s 25; 2021 c 287 s 18; 2016 c 155 s 15; 2009 c 217 s 13; 2003 c 283 s 25.]
Notes:
Effective date—2025 c 58 ss 5058-5170: See note following RCW 7.68.030.
Explanatory note—2025 c 58: See note following RCW 1.16.050.
Effective date—2024 c 62 ss 1-8, 10-18, 20-26, 28, and 30-32: See note following RCW 18.71A.010.
Intent—2024 c 62: See note following RCW 18.71A.020.

catchline: Long-term care facility residents—Readmission after inpatient behavioral health treatment—Evaluation, report to legislature. (Effective until June 30, 2027.)