Health care services

AN ACT Relating to preserving access to protected health care 1
services by requiring department of health review of certain health 2
care business transactions which could affect access to protected 3
health care services while balancing access to community health 4
services; giving authority to the department of health to approve, 5
approve with conditions or modifications, or deny health care 6
business transactions, and establishing the process and requirements 7
for such determination; giving authority to the attorney general to 8
enjoin qualifying health care business transactions not approved or 9
approved with conditions or modifications by the department of 10
health; and directing the collection of data and provision of 11
information, analysis, and reporting regarding access to protected 12
health care services; amending RCW 43.370.030; adding a new chapter 13
to Title 70 RCW; and providing effective dates. 14
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:15
PART I16
FINDINGS, INTENT, AND DEFINITIONS17
NEW SECTION. Sec. 1. The legislature finds that protecting the 18
accessibility of reproductive health care, end-of-life care, and 19
gender-affirming care in communities across the state requires 20
H-0163.1
HOUSE BILL 1072
State of Washington 69th Legislature 2025 Regular Session
By Representatives Walen, Leavitt, Reeves, Berg, Ryu, Ramel, Reed,
Callan, Goodman, Pollet, Nance, Ormsby, Lekanoff, and Hill
Prefiled 12/16/24. Read first time 01/13/25. Referred to Committee
on Health Care & Wellness.
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additional analysis and scrutiny. It is the intent of the legislature 1
to ensure that residents have access to these services in the 2
communities in which they live. In order to provide communities, 3
health care providers, and state regulators the information they need 4
to ensure adequate access to these protected services, the 5
legislature intends to update the statewide health resource strategy 6
to specifically include ongoing analysis of the availability of these 7
services. Additionally, the legislature intends to empower the 8
department of health to scrutinize health care transactions that 9
would directly affect access to care that is the subject of the 10
reproductive privacy act, care that is the subject of the death with 11
dignity act, and gender affirming health care. In considering the 12
effect of health care transactions, the legislature is also aware 13
that denial or delay of such transactions may lead to health care 14
service disruption or loss of critically important community health 15
care services including hospital care, emergency care, specialty 16
care, primary care, obstetric care, or other services. The 17
legislature intends that regulation of such transactions by the 18
department in order to protect access to these sensitive health care 19
services is additive and complementary to the existing powers given 20
to the attorney general to review transactions for anticompetitive 21
conduct and consumer harm. 22
NEW SECTION. Sec. 2. The definitions in this section apply 23
throughout this chapter unless the context clearly requires 24
otherwise.25
(1) "Community health care services" means hospital care, 26
emergency care, specialty care, primary care, obstetric care, or 27
other health services important to the community. 28
(2) "Department" means the Washington state department of health.29
(3) "Gender affirming health care" means care for an individual 30
to support and affirm the individual's gender identity. Gender 31
affirming treatment includes, but is not limited to, treatment for 32
gender dysphoria. Gender affirming health care can be prescribed to 33
two spirit, transgender, nonbinary, and other gender diverse 34
individuals. 35
(4) "Health care entity" means: 36
(a) Provider organizations; 37
(b) Hospitals; 38
(c) Health systems; or 39
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(d) Carriers or insurance holding company systems as defined in 1
RCW 48.31B.005. 2
(5) "Health care transaction" or "transaction" means a business 3
transaction by purchase, merger, or joint venture where one party is 4
a health care entity. 5
(6) "Health district" has the same meaning as in RCW 70.05.010.6
(7) "Health system" means: 7
(a) A parent corporation of one or more hospitals and any entity 8
affiliated with such parent corporation through ownership or control; 9
or 10
(b) A hospital and any entity affiliated with such hospital 11
through ownership. 12
(8) "Hospital" means any entity that is licensed under chapter 13
70.41 or 71.12 RCW. 14
(9) "Person" means an individual, a trust or estate, a 15
partnership, a corporation including associations, limited liability 16
companies, joint stock companies, and insurance companies.17
(10)(a) "Protected health care services" means:18
(i) Reproductive services that are the subject of the 19
reproductive privacy act established pursuant to Initiative Measure 20
No. 120, approved November 5, 1991; 21
(ii) Death with dignity services that are the subject of the 22
Washington death with dignity act established pursuant to Initiative 23
Measure No. 1000, approved November 4, 2008; and 24
(iii) Gender affirming health care. 25
(b) Protected health care services may be provided virtually, on 26
demand, or in brick-and-mortar settings. 27
(11) "Provider" means a natural person who (a) has primary 28
responsibility for the care of a patient receiving protected health 29
care services within the person's scope of practice and (b) practices 30
a profession identified in RCW 18.130.040. 31
(12) "Provider organization" means a corporation, partnership, 32
business trust, association, or organized group of persons, whether 33
incorporated or not, which is in the business of health care delivery 34
or management and that represents seven or more health care providers 35
in contracting with carriers or third-party administrators for the 36
payments of health care services. A "provider organization" includes 37
physician organizations, physician-hospital organizations, 38
independent practice associations, provider networks, and accountable 39
care organizations. 40
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PART II1
TRANSACTION APPLICATION AND REVIEW2
NEW SECTION. Sec. 3. (1) A health care entity that provides 3
protected health care services may not engage in a health care 4
transaction which may as of the time of the transaction affect access 5
to protected health care services in one or more health districts 6
without the transaction first having received the approval of the 7
department under this chapter.8
(2) Not less than 60 days prior to the effective date of a 9
transaction subject to this section, a party to the transaction must 10
submit an application to the department on forms provided by the 11
department. The forms provided by the department must require the 12
following: 13
(a) The name of the health care entities; 14
(b) A brief description of the transaction; 15
(c) A brief description of how protected health care services 16
will be unchanged, increased, limited, or reduced as a result of the 17
health care transaction, including the geographic areas affected;18
(d) If applicable, a description of how the transaction will 19
promote access to community health care services; and20
(e) The health entity's or entities' proposed plan to address any 21
reduction or limitation to access to protected health care services.22
(3) The applications and all supporting documents submitted to 23
the department are considered public records for purposes of chapter 24
42.56 RCW. 25
(4) The department shall charge an application fee sufficient to 26
cover the costs of implementing this chapter. 27
NEW SECTION. Sec. 4. (1) The department shall determine if the 28
application required under section 3 of this act is complete for the 29
purposes of review. The department may find that an application is 30
incomplete if a question on the application form has not been 31
answered in whole or in part or has been answered in a manner that 32
does not fairly meet the question addressed. If the department 33
determines that an application is incomplete, the department shall 34
notify the applicant within 15 working days after the date the 35
application was received stating the reasons for its determination of 36
incompleteness, with reference to the particular questions for which 37
a deficiency is noted.38
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(2) Within five working days of receipt of a completed 1
application, the department shall publish notice of the application 2
on the department's publicly accessible website and in a newspaper of 3
general circulation in the county or counties where the health care 4
entity is located and shall notify by first-class United States mail, 5
email, or fax any person who has requested notice of the filing of 6
such applications. The notice must state that an application has been 7
received, state the names of the intended parties, describe the 8
contents of the application, state the date and location of any 9
public hearings, and state the date by which a person may submit 10
written comments about the application to the department.11
(3) Within five working days of receipt of a completed 12
application, the department must provide the completed application to 13
the attorney general. 14
NEW SECTION. Sec. 5. (1) Upon receipt of a completed 15
application under this chapter, the department must conduct a review 16
and issue a final determination within 60 days. If the department 17
fails to issue a final determination within 60 days, the health care 18
transaction is deemed approved.19
(2)(a) The department may conduct up to two public hearings 20
during the course of review, at least one of which must be in the 21
health district most affected by the proposed health care 22
transaction. 23
(b) The department must allow individuals to participate remotely 24
in public hearings. 25
(c) At a public hearing, anyone may file written comments and 26
exhibits or appear and make a statement. 27
(d) A public hearing must be held not later than 30 days after 28
receipt of a completed application. All public hearings must be 29
completed not later than 45 days after receipt of a completed 30
application. At least 10 days' public notice must be given before the 31
holding of a public hearing. 32
(3) The department shall consult with the attorney general to 33
ensure that the applicants are also in compliance with chapter 19.390 34
RCW. 35
(4) The department shall consult with the health district or 36
districts affected by the proposed transaction to evaluate the 37
application and its foreseeable effects to protected health care 38
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services and community health care services under the standards 1
established in section 6 of this act. 2
PART III3
TRANSACTION APPROVAL STANDARDS AND FINAL DETERMINATION4
NEW SECTION. Sec. 6. (1) The department shall only approve or 5
approve with conditions or modifications an application under this 6
chapter if the department determines that:7
(a) The health care transaction subject to review under this 8
chapter will not, at the time of transaction, foreseeably and 9
meaningfully reduce access to protected health care services in one 10
or more health districts; 11
(b) The health care entity engaging in the health care 12
transaction subject to review under this chapter has or plans to take 13
sufficient safeguards to address any reduction in access to protected 14
health care services such that the health care transaction will not 15
meaningfully reduce the continued existence of protected health 16
services within one or more health districts, or that sufficient 17
alternative sources of care are available in the health district; or18
(c) The health care transaction is necessary to preserve access 19
to community health care services because, without the transaction, 20
the residents of one or more health districts are more likely than 21
not to lose community health care services that would meaningfully 22
reduce access to care for these residents, including hospital care, 23
emergency care, specialty care, primary care, obstetric services, or 24
other services important to the community. 25
(2) In determining whether to approve, approve with conditions or 26
modifications, or deny an application under this section, the 27
department shall consider the following information alongside the 28
application received from the parties of the health care transaction:29
(a) Information and analysis provided in the report required 30
under section 11 of this act regarding existing access to protected 31
health care services in the health district or districts that would 32
be affected by the transaction, and the effect of the health care 33
transaction on existing access; 34
(b) If applicable, information provided in the most recent 35
community health needs assessment under Title 26 U.S.C. Sec. 501 36
relevant to protected health care services; 37
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(c) Comments, information, and statements provided at public 1
hearings pursuant to section 5 of this act; 2
(d) The share of residents within the health district or 3
districts who would have their current site of care for protected 4
health care services or community health care services relocated, and 5
whether such relocation would add barriers to accessing protected 6
health care services or community health care services to those 7
residents; and 8
(e) The share of residents within the health district or 9
districts who would have the modality of accessing protected health 10
care services or community health care services changed from only 11
brick-and-mortar to only virtual or on demand, and whether such 12
residents would have adequate access to necessary resources to access 13
virtual or on demand services. 14
NEW SECTION. Sec. 7. (1) The department shall make a final 15
determination regarding an application subject to review under this 16
chapter, with or without any specific modifications or conditions 17
based on the standards established in section 6 of this act.18
(2)(a) Within 60 days of receipt of a completed application under 19
this chapter, the department shall make a final determination to:20
(i) Approve the application in writing, which constitutes a final 21
decision; 22
(ii) Approve the application with conditions or modifications on 23
the transaction to ensure the requirements in section 6 of this act 24
are met. The imposition of such modifications or conditions must be 25
in writing and constitutes a final decision; or 26
(iii) Disapprove the application in writing, which constitutes a 27
final decision. 28
(b) The department shall make its final determination in writing 29
provided to all parties in the transaction, including findings and 30
justification of its determination related to the standards 31
established in section 6 of this act. 32
(c) The final determination must adhere to the notice 33
requirements in the same manner as under section 4(2) of this act.34
(3)(a) The department may not make its decision subject to any 35
condition not directly related to the requirements of this chapter, 36
and any condition or modification, including the cost associated with 37
such condition or modification, must be reasonable and bear a direct 38
and rational relationship to the application under review.39
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(b) Any modifications or conditions imposed by the department 1
must: 2
(i) Align with the relevant applicable standards of care for the 3
specific service or services affected by the modifications or 4
conditions; 5
(ii) Relate to the specific application and consider preservation 6
of access to health care services; and 7
(iii) Not impose undue financial burden to the parties such that 8
provision of health care services provided by the health care entity 9
cannot be done in a financially feasible manner. 10
(c) The decision to approve, approve with conditions or 11
modifications, or disapprove an application must take into account 12
whether disapproval of a plan, or specific conditions or 13
modifications, may lead to health care service disruption or loss of 14
community health care services to the community. 15
(4) A health care entity engaged in a health care transaction 16
subject to this chapter and affected by a final decision of the 17
department to approve, approve with conditions or modifications, or 18
disapprove an application has the right to an adjudicative proceeding 19
under chapter 34.05 RCW. 20
PART IV21
ENFORCEMENT, RULE MAKING, AND CONTRACTING AUTHORITY22
NEW SECTION. Sec. 8. The attorney general may seek an 23
injunction to prevent any health care transaction required to seek 24
and receive approval pursuant to section 3 of this act that is not 25
approved or approved with conditions or modifications by the 26
department under this chapter.27
NEW SECTION. Sec. 9. (1) The department shall require annual 28
reports from the parties to a health care transaction that was 29
subject to review and approved or approved with conditions or 30
modifications under this chapter for the purpose of ensuring 31
compliance with the parties' application, the department's approval, 32
and this chapter.33
(2) The department shall require annual reports under this 34
section for a period of not more than three years after the 35
completion of a transaction approved or approved with conditions or 36
modifications. 37
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NEW SECTION. Sec. 10. The department may adopt rules necessary 1
to implement this chapter and may contract with and provide 2
reasonable reimbursement to qualified persons to assist in 3
determining whether the requirements of section 6 of this act have 4
been met.5
PART V6
REPORT ON HEALTH CARE SERVICES7
NEW SECTION. Sec. 11. (1) The department, in coordination with 8
the office of financial management under chapter 43.370 RCW and in 9
consultation with health districts, shall create a report on existing 10
access to protected health care services and community health care 11
services within individual health districts and statewide.12
(2) The report must include a description of relevant population 13
demographics, the extent to which protected health care services and 14
community health care services are covered by state or federal 15
coverage programs or other health plans, and trends in relevant 16
health status and health care needs. 17
(3) The report must be made available publicly for the purposes 18
of health care planning and analysis. In doing so, the department 19
shall ensure that requirements for confidentiality of patient, 20
provider, and facility-specific records are met. 21
(4) The report must be made publicly available by December 1, 22
2026, and updated no less frequently than every two years.23
PART VI24
STATEWIDE HEALTH RESOURCES STRATEGY25
Sec. 12. RCW 43.370.030 and 2010 1st sp.s. c 7 s 114 are each 26
amended to read as follows: 27
(1) The office shall develop a statewide health resources 28
strategy. The strategy shall establish statewide health planning 29
policies and goals related to the availability of health care 30
facilities and services, quality of care, and cost of care. The 31
strategy shall identify needs according to geographic regions 32
suitable for comprehensive health planning as designated by the 33
office. 34
(2) The development of the strategy shall consider the following 35
general goals and principles: 36
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(a) That excess capacity of health services and facilities place 1
considerable economic burden on the public who pay for the 2
construction and operation of these facilities as patients, health 3
insurance purchasers, carriers, and taxpayers; and 4
(b) That the development and ongoing maintenance of current and 5
accurate health care information and statistics related to cost and 6
quality of health care, as well as projections of need for health 7
facilities and services, are essential to effective strategic health 8
planning. 9
(3) The strategy, with public input by health service areas, 10
shall include: 11
(a) A health system assessment and objectives component that:12
(i) Describes state and regional population demographics, health 13
status indicators, and trends in health status and health care needs; 14
and 15
(ii) Identifies key policy objectives for the state health system 16
related to access to care, health outcomes, quality, and cost-17
effectiveness; 18
(b) A health care facilities and services plan that shall assess 19
the demand for health care facilities and services to inform state 20
health planning efforts ((and)), direct certificate of need 21
determinations((,)) for those facilities and services subject to 22
certificate of need as provided in chapter 70.38 RCW, and provide 23
information and analysis of protected health care services and 24
community health care services required under section 6 of this act . 25
The plan shall include: 26
(i) An inventory of each geographic region's existing health care 27
facilities and services , with specific analysis of the availability 28
of protected health care services and community health care services 29
as defined in section 2 of this act; 30
(ii) Projections of need for each category of health care 31
facility and service, including those subject to certificate of need;32
(iii) Policies to guide the addition of new or expanded health 33
care facilities and services to promote the use of quality, evidence-34
based, cost-effective health care delivery options, including any 35
recommendations for criteria, standards, and methods relevant to the 36
certificate of need review process; and 37
(iv) An assessment of the availability of health care providers, 38
public health resources, transportation infrastructure, and other 39
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considerations necessary to support the needed health care facilities 1
and services in each region; 2
(c) A health care data resource plan that identifies data 3
elements necessary to properly conduct planning activities and to 4
review certificate of need applications, including data related to 5
inpatient and outpatient utilization and outcomes information, and 6
financial and utilization information related to charity care, 7
quality, and cost. The plan shall inventory existing data resources, 8
both public and private, that store and disclose information relevant 9
to the health planning process, including information necessary to 10
conduct certificate of need activities pursuant to chapter 70.38 RCW. 11
The plan shall identify any deficiencies in the inventory of existing 12
data resources and the data necessary to conduct comprehensive health 13
planning activities. The plan may recommend that the office be 14
authorized to access existing data sources and conduct appropriate 15
analyses of such data or that other agencies expand their data 16
collection activities as statutory authority permits. The plan may 17
identify any computing infrastructure deficiencies that impede the 18
proper storage, transmission, and analysis of health planning data. 19
The plan shall provide recommendations for increasing the 20
availability of data related to health planning to provide greater 21
community involvement in the health planning process and consistency 22
in data used for certificate of need applications and determinations;23
(d) An assessment of emerging trends in health care delivery and 24
technology as they relate to access to health care facilities and 25
services, quality of care, and costs of care. The assessment shall 26
recommend any changes to the scope of health care facilities and 27
services covered by the certificate of need program that may be 28
warranted by these emerging trends. In addition, the assessment may 29
recommend any changes to criteria used by the department to review 30
certificate of need applications, as necessary; 31
(e) A rural health resource plan to assess the availability of 32
health resources in rural areas of the state, assess the unmet needs 33
of these communities, and evaluate how federal and state 34
reimbursement policies can be modified, if necessary, to more 35
efficiently and effectively meet the health care needs of rural 36
communities. The plan shall consider the unique health care needs of 37
rural communities, the adequacy of the rural health workforce, and 38
transportation needs for accessing appropriate care.39
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(4) The office shall submit the initial strategy to the governor 1
and the appropriate committees of the senate and house of 2
representatives by January 1, 2010. Every two years the office shall 3
submit an updated strategy. The health care facilities and services 4
plan as it pertains to a distinct geographic planning region may be 5
updated by individual categories on a rotating, biannual schedule.6
(5) The office shall hold at least one public hearing and allow 7
opportunity to submit written comments prior to the issuance of the 8
initial strategy or an updated strategy. A public hearing shall be 9
held prior to issuing a draft of an updated health care facilities 10
and services plan, and another public hearing shall be held before 11
final adoption of an updated health care facilities and services 12
plan. Any hearing related to updating a health care facilities and 13
services plan for a specific planning region shall be held in that 14
region with sufficient notice to the public and an opportunity to 15
comment. 16
PART VII17
MISCELLANEOUS PROVISIONS18
NEW SECTION. Sec. 13. Sections 2 through 11 of this act 19
constitute a new chapter in Title 70 RCW.20
NEW SECTION. Sec. 14. If any provision of this act or its 21
application to any person or circumstance is held invalid, the 22
remainder of the act or the application of the provision to other 23
persons or circumstances is not affected.24
NEW SECTION. Sec. 15. This act takes effect December 1, 2026, 25
and applies to health care transactions with an effective date on or 26
after the effective date of this act, except for section 9 which 27
takes effect July 1, 2026.28
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