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Washington State Institute for Public Policy

Traumatic Brain Injury Services

The 2023 Washington State Legislature directed WSIPP to study the potential need for developing specialized long-term services and supports for adults with traumatic brain injuries (TBIs). At a minimum, the study must include the following:

  • The demographics of adults with traumatic brain injuries in the state who are anticipated to require long-term services and supports, including an examination of those who are likely to be eligible for Medicaid long-term services and supports;
  • The industry standards of providing long-term care services and supports to individuals with traumatic brain injuries; and
  • Other states' methods to provide long-term services and support to individuals with TBIs including the rates paid for these services and a description of any specialized facilities established to deliver these services.
The report is due to the governor and the legislature by June 30, 2025.
Benjamin MacCormack-Gelles, (360) 664-9080 View Legislation

Hospital Staffing Standards

The 2023 Washington State Legislature directed WSIPP to study hospital staffing standards for direct-care registered nurses and direct-care nursing assistants. As part of the study, WSIPP must review current and historical staffing plans filed with the Washington State Department of Health (DOH) and describe the following:
  • Timeliness and completeness of filed forms;
  • Format of filed forms;
  • Patient care unit nursing staff assignments related to the maximum number of patients to which a direct care nursing or nursing assistant may be assigned;
  • Descriptive statistics on submissions by hospital unit type;
  • Trends over time, if any;
  • Legal minimum staffing standards for registered nurses and nursing assistants in other jurisdictions; and
  • Relevant professional association guidance, recommendations, or best practices.
The report is due to DOH and the legislature by June 30, 2024.
Cory Briar, (360) 664-9801 View Legislation

Emergency Medical Services


The 2024 Washington State Legislature directed WSIPP, in collaboration with the Department of Health (DOH) and the Health Care Authority (HCA), to study the current landscape of emergency medical services (EMS) in Washington. The study aims to evaluate the current EMS landscape and explore how other states fund or have considered funding EMS through federal, state, or local government.

WSIPP’s study includes examining trends in the number and types of EMS available, the volume of 911 responses, and the volume of interfacility transports provided by EMS organizations. Trends will be examined over time and across counties in Washington. Our study will also estimate the projected need for EMS services over the next two years.

Furthermore, WSIPP’s study will identify geographic disparities in EMS access, specifically noting areas without access to EMS services within a 25-minute average response time. WSIPP is also tasked with estimating the costs required to address gaps in EMS coverage and ensure timely access to services statewide.

In addition, the study will investigate models for EMS used by other states and review existing research and literature on EMS funding strategies.

To inform its findings, WSIPP will engage with EMS organizations, local governments, hospitals, labor organizations representing EMS personnel, and other relevant stakeholders identified by WSIPP and DOH, HCA, and the Office of the Insurance Commissioner.

A report is due to DOH and the legislature by June 1, 2026.
Amani Rashid, (360) 664-9804 View Legislation