HB 1864
In CommitteeHouse
Ambulances/transport options
Transporting patients by ambulance to facilities other than emergency departments.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill expands the types of facilities to which ambulances can legally transport patients—beyond just emergency departments—to include urgent care clinics, mental health facilities, and substance use disorder programs. It also requires health plans to cover such ambulance trips and updates state policies to support this broader transport model.
- Ambulance services may now transport patients to facilities other than emergency departments—including urgent care clinics, mental health facilities, and substance use disorder programs—as authorized in regional emergency medical services plans.
- Health plans issued or renewed on or after January 1, 2026 must cover ground ambulance transport to such alternative facilities.
- Starting January 1, 2025, health carriers must cover ambulance transport to behavioral health emergency services for enrollees with emergency medical conditions, without requiring prior authorization if a prudent layperson would believe an emergency existed.
- The Health Care Authority must develop a new reimbursement method for ambulance services transporting Medicaid enrollees to non-emergency departments.
- Regional emergency medical services councils must include procedures for appropriate transport to alternative facilities in their regional plans, including criteria for destination selection and interfacility transfers.
Who is affected
- Patients needing alternative care settings — Patients who need non-emergency medical care—such as urgent care, mental health, or substance use disorder services—can now be transported by ambulance to these facilities instead of being automatically taken to an emergency department, especially when appropriate based on their condition.
- Ambulance services and providers — Ambulance services gain legal authorization to transport patients to facilities beyond emergency departments, and must follow regional emergency medical services plans that include such transport options.
- Health insurance carriers — Health insurers must cover ground ambulance transport to non-emergency departments (e.g., urgent care, mental health, substance use programs) for plans issued or renewed on or after January 1, 2025 or 2026, depending on the provision.
- State health agencies and regional EMS councils — State agencies like the Department of Health and the Health Care Authority must update policies, reimbursement methods, and regional planning to support and regulate transport to alternative facilities.
- Emergency medical personnel — Emergency medical personnel (EMTs, paramedics, etc.) gain legal protection when transporting patients to alternative facilities in good faith, as part of their emergency medical services duties.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (5)
Patients in behavioral health or substance use crises can now be transported directly to appropriate facilities without being routed through emergency departments, reducing inappropriate ED use, avoiding criminalization (e.g., for intoxication or decompensation), and enabling timely, clinically appropriate care—especially critical for people experiencing homelessness or without transportation.
HealthcarePeopleRef: Sec. 1 (amended RCW 18.73.280) and Sec. 3(1)(a) (amended RCW 48.43.121)Eliminating prior authorization for behavioral health emergency transports protects patient autonomy and dignity by allowing paramedics and emergency medical personnel to use clinical judgment in good faith, reducing delays and intrusive administrative barriers that disproportionately affect people with mental illness or addiction.
Rights & LibertiesPeopleRef: Sec. 3(1)(a) (amended RCW 48.43.121)Emergency medical personnel gain legal protection when transporting patients to alternative facilities in good faith, reducing fear of liability and encouraging appropriate use of non-emergency destinations—supporting safer, more confident decision-making in high-stakes clinical scenarios.
Public SafetyPeopleRef: Sec. 7 (amended RCW 18.71.210(5))Medicaid enrollees gain access to appropriate, non-emergency destinations for behavioral health and substance use services via ambulance, reducing unnecessary ED visits and associated costs—potentially improving continuity of care and outcomes for one of Washington’s most vulnerable populations.
HealthcarePeopleRef: Sec. 4 (amended RCW 74.09.330)Regional EMS councils are required to include protocols for appropriate transport to alternative facilities, enabling local communities to tailor response systems to regional needs—especially valuable in rural areas where EDs are scarce and behavioral health resources are limited.
Local GovernmentPeopleRef: Sec. 6 (amended RCW 70.168.100(1)(i))
Potential Concerns (4)
Health insurers and state Medicaid programs will incur new costs to cover ambulance transport to non-emergency facilities, including administrative overhead for reimbursement design and claims processing; while current use is limited, this expands liability exposure and operational complexity for payers, potentially leading to higher premiums or reduced coverage flexibility over time.
FinancialPeopleRef: Sec. 2 (new RCW 41.05.010) and Sec. 3(1)(b) (amended RCW 48.43.121)Ambulance providers may face clinical and logistical uncertainty when deciding whether a patient’s condition warrants transport to an urgent care or behavioral health facility instead of an emergency department—especially in ambiguous cases—potentially leading to under- or over-triage, delayed definitive care, or liability exposure if outcomes are poor.
Public SafetyPeopleRef: Sec. 4 (amended RCW 74.09.330) and Sec. 1 (amended RCW 18.73.280)Urgent care clinics and behavioral health facilities may experience increased demand and strain on capacity if ambulances begin diverting patients to them, but they are not required or incentivized to expand services—potentially leading to overcrowding, longer wait times, or refusal of transfers, especially in rural or underserved regions.
Business & EmploymentLean peopleRef: Sec. 1 (amended RCW 18.73.280) and Sec. 6 (amended RCW 70.168.100)The bill allows insurers to apply copays, coinsurance, and deductibles for non-emergency ambulance trips, which may deter low-income patients from using this option—even when clinically appropriate—due to out-of-pocket cost concerns, undermining the policy’s intended access goal.
HealthcareLean peopleRef: Sec. 3(1)(b) (amended RCW 48.43.121)
Who Is Most Affected
Patients in behavioral health or substance use crises benefit significantly: they avoid unnecessary ED visits, reduce exposure to criminal justice systems, and receive more appropriate care in dedicated facilities—though those with high deductibles may still face cost barriers.
Ambulance providers gain legal protection and expanded operational flexibility, but face new clinical and administrative burdens—especially in determining destination appropriateness without clear clinical guidelines or backup capacity at alternative facilities.
Health insurers face new coverage obligations and administrative costs, but the fiscal impact is modest given current low utilization; however, the ability to apply cost-sharing may limit actual access for low-income enrollees despite coverage mandates.
State agencies (DOH, HCA) and regional councils gain authority to modernize EMS planning, but must invest in new policy development, training, and oversight—especially to ensure equitable access in rural and underserved areas.
EMTs and paramedics gain liability protection and clinical discretion, improving job satisfaction and reducing fear of liability—but may face increased stress in ambiguous triage decisions without robust support systems.