Cardiac care cert. of need

AN ACT Relating to updating certificate of need requirements to 1
promote the stability, efficiency, and equitableness of Washington's 2
cardiac care delivery system; amending RCW 70.38.128; and reenacting 3
and amending RCW 70.38.111. 4
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:5
Sec. 1. RCW 70.38.128 and 2007 c 440 s 1 are each amended to 6
read as follows: 7
(1) To promote the stability , efficiency, and equitableness of 8
Washington's cardiac care delivery system, ((by July 1, 2008, )) the 9
department of health shall adopt rules establishing criteria for the 10
issuance of a certificate of need under this chapter for the 11
performance of elective percutaneous coronary interventions ((at 12
hospitals that do not otherwise provide on-site cardiac surgery.13
Prior to initiating rule making, the department shall contract 14
for an independent evidence-based review of the circumstances under 15
which elective percutaneous coronary interventions should be allowed 16
in Washington at hospitals that do not otherwise provide on-site 17
cardiac surgery. The review shall address, at a minimum, factors 18
related to access to care, patient safety, quality outcomes, costs, 19
and the stability of Washington's cardiac care delivery system and of 20
existing cardiac care providers, and ensure that elective coronary 21
H-1339.1
HOUSE BILL 1979
State of Washington 69th Legislature 2025 Regular Session
By Representatives Bronoske, Schmick, Timmons, Reed, and Obras
Read first time 02/14/25. Referred to Committee on Health Care &
Wellness.
p. 1 HB 1979
intervention volumes at the University of Washington academic medical 1
center are maintained at levels required for training of 2
cardiologists consistent with applicable accreditation requirements. 3
The department shall consider the results of this review, and any 4
associated recommendations, in adopting these rules )). The rules must 5
be consistent with the certificate of need exemption in RCW 6
70.38.111(15).7
(2) In adopting rules under this section, the department shall 8
consider national standards for patient safety and quality outcomes, 9
the ability for patients to access care in their communities, and the 10
ongoing stability of Washington's cardiac care delivery system.11
Sec. 2. RCW 70.38.111 and 2024 c 259 s 5, 2024 c 165 s 1, and 12
2024 c 121 s 23 are each reenacted and amended to read as follows:13
(1) The department shall not require a certificate of need for 14
the offering of an inpatient tertiary health service by:15
(a) A health maintenance organization or a combination of health 16
maintenance organizations if (i) the organization or combination of 17
organizations has, in the service area of the organization or the 18
service areas of the organizations in the combination, an enrollment 19
of at least 50,000 individuals, (ii) the facility in which the 20
service will be provided is or will be geographically located so that 21
the service will be reasonably accessible to such enrolled 22
individuals, and (iii) at least 75 percent of the patients who can 23
reasonably be expected to receive the tertiary health service will be 24
individuals enrolled with such organization or organizations in the 25
combination; 26
(b) A health care facility if (i) the facility primarily provides 27
or will provide inpatient health services, (ii) the facility is or 28
will be controlled, directly or indirectly, by a health maintenance 29
organization or a combination of health maintenance organizations 30
which has, in the service area of the organization or service areas 31
of the organizations in the combination, an enrollment of at least 32
50,000 individuals, (iii) the facility is or will be geographically 33
located so that the service will be reasonably accessible to such 34
enrolled individuals, and (iv) at least 75 percent of the patients 35
who can reasonably be expected to receive the tertiary health service 36
will be individuals enrolled with such organization or organizations 37
in the combination; or 38
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(c) A health care facility (or portion thereof) if (i) the 1
facility is or will be leased by a health maintenance organization or 2
combination of health maintenance organizations which has, in the 3
service area of the organization or the service areas of the 4
organizations in the combination, an enrollment of at least 50,000 5
individuals and, on the date the application is submitted under 6
subsection (2) of this section, at least 15 years remain in the term 7
of the lease, (ii) the facility is or will be geographically located 8
so that the service will be reasonably accessible to such enrolled 9
individuals, and (iii) at least 75 percent of the patients who can 10
reasonably be expected to receive the tertiary health service will be 11
individuals enrolled with such organization; 12
if, with respect to such offering or obligation by a nursing home, 13
the department has, upon application under subsection (2) of this 14
section, granted an exemption from such requirement to the 15
organization, combination of organizations, or facility.16
(2) A health maintenance organization, combination of health 17
maintenance organizations, or health care facility shall not be 18
exempt under subsection (1) of this section from obtaining a 19
certificate of need before offering a tertiary health service unless:20
(a) It has submitted at least 30 days prior to the offering of 21
services reviewable under RCW 70.38.105(4)(d) an application for such 22
exemption; and 23
(b) The application contains such information respecting the 24
organization, combination, or facility and the proposed offering or 25
obligation by a nursing home as the department may require to 26
determine if the organization or combination meets the requirements 27
of subsection (1) of this section or the facility meets or will meet 28
such requirements; and 29
(c) The department approves such application. The department 30
shall approve or disapprove an application for exemption within 30 31
days of receipt of a completed application. In the case of a proposed 32
health care facility (or portion thereof) which has not begun to 33
provide tertiary health services on the date an application is 34
submitted under this subsection with respect to such facility (or 35
portion), the facility (or portion) shall meet the applicable 36
requirements of subsection (1) of this section when the facility 37
first provides such services. The department shall approve an 38
application submitted under this subsection if it determines that the 39
applicable requirements of subsection (1) of this section are met.40
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(3) A health care facility (or any part thereof) with respect to 1
which an exemption was granted under subsection (1) of this section 2
may not be sold or leased and a controlling interest in such facility 3
or in a lease of such facility may not be acquired and a health care 4
facility described in subsection (1)(c) of this section which was 5
granted an exemption under subsection (1) of this section may not be 6
used by any person other than the lessee described in subsection 7
(1)(c) of this section unless: 8
(a) The department issues a certificate of need approving the 9
sale, lease, acquisition, or use; or 10
(b) The department determines, upon application, that (i) the 11
entity to which the facility is proposed to be sold or leased, which 12
intends to acquire the controlling interest, or which intends to use 13
the facility is a health maintenance organization or a combination of 14
health maintenance organizations which meets the requirements of 15
subsection (1)(a)(i) of this section, and (ii) with respect to such 16
facility, meets the requirements of subsection (1)(a)(ii) or (iii) of 17
this section or the requirements of subsection (1)(b)(i) and (ii) of 18
this section. 19
(4) In the case of a health maintenance organization, an 20
ambulatory care facility, or a health care facility, which ambulatory 21
or health care facility is controlled, directly or indirectly, by a 22
health maintenance organization or a combination of health 23
maintenance organizations, the department may under the program apply 24
its certificate of need requirements to the offering of inpatient 25
tertiary health services to the extent that such offering is not 26
exempt under the provisions of this section or RCW 70.38.105(7).27
(5)(a) The department shall not require a certificate of need for 28
the construction, development, or other establishment of a nursing 29
home, or the addition of beds to an existing nursing home, that is 30
owned and operated by a continuing care retirement community that:31
(i) Offers services only to contractual members;32
(ii) Provides its members a contractually guaranteed range of 33
services from independent living through skilled nursing, including 34
some assistance with daily living activities; 35
(iii) Contractually assumes responsibility for the cost of 36
services exceeding the member's financial responsibility under the 37
contract, so that no third party, with the exception of insurance 38
purchased by the retirement community or its members, but including 39
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the medicaid program, is liable for costs of care even if the member 1
depletes his or her personal resources; 2
(iv) Has offered continuing care contracts and operated a nursing 3
home continuously since January 1, 1988, or has obtained a 4
certificate of need to establish a nursing home; 5
(v) Maintains a binding agreement with the state assuring that 6
financial liability for services to members, including nursing home 7
services, will not fall upon the state; 8
(vi) Does not operate, and has not undertaken a project that 9
would result in a number of nursing home beds in excess of one for 10
every four living units operated by the continuing care retirement 11
community, exclusive of nursing home beds; and 12
(vii) Has obtained a professional review of pricing and long-term 13
solvency within the prior five years which was fully disclosed to 14
members. 15
(b) A continuing care retirement community shall not be exempt 16
under this subsection from obtaining a certificate of need unless:17
(i) It has submitted an application for exemption at least 30 18
days prior to commencing construction of, is submitting an 19
application for the licensure of, or is commencing operation of a 20
nursing home, whichever comes first; and 21
(ii) The application documents to the department that the 22
continuing care retirement community qualifies for exemption.23
(c) The sale, lease, acquisition, or use of part or all of a 24
continuing care retirement community nursing home that qualifies for 25
exemption under this subsection shall require prior certificate of 26
need approval to qualify for licensure as a nursing home unless the 27
department determines such sale, lease, acquisition, or use is by a 28
continuing care retirement community that meets the conditions of (a) 29
of this subsection. 30
(6) A rural hospital, as defined by the department, reducing the 31
number of licensed beds to become a rural primary care hospital under 32
the provisions of Part A Title XVIII of the Social Security Act 33
Section 1820, 42 U.S.C., 1395c et seq. may, within three years of the 34
reduction of beds licensed under chapter 70.41 RCW, increase the 35
number of licensed beds to no more than the previously licensed 36
number without being subject to the provisions of this chapter.37
(7) A rural health care facility licensed under RCW 70.175.100 38
formerly licensed as a hospital under chapter 70.41 RCW may, within 39
three years of the effective date of the rural health care facility 40
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license, apply to the department for a hospital license and not be 1
subject to the requirements of RCW 70.38.105(4)(a) as the 2
construction, development, or other establishment of a new hospital, 3
provided there is no increase in the number of beds previously 4
licensed under chapter 70.41 RCW and there is no redistribution in 5
the number of beds used for acute care or long-term care, the rural 6
health care facility has been in continuous operation, and the rural 7
health care facility has not been purchased or leased.8
(8) A rural hospital determined to no longer meet critical access 9
hospital status for state law purposes as a result of participation 10
in the Washington rural health access preservation pilot identified 11
by the state office of rural health and formerly licensed as a 12
hospital under chapter 70.41 RCW may apply to the department to renew 13
its hospital license and not be subject to the requirements of RCW 14
70.38.105(4)(a) as the construction, development, or other 15
establishment of a new hospital, provided there is no increase in the 16
number of beds previously licensed under chapter 70.41 RCW. If all or 17
part of a formerly licensed rural hospital is sold, purchased, or 18
leased during the period the rural hospital does not meet critical 19
access hospital status as a result of participation in the Washington 20
rural health access preservation pilot and the new owner or lessor 21
applies to renew the rural hospital's license, then the sale, 22
purchase, or lease of part or all of the rural hospital is subject to 23
the provisions of this chapter. 24
(9)(a) A nursing home that voluntarily reduces the number of its 25
licensed beds to provide assisted living, licensed assisted living 26
facility care, adult day care, adult day health, respite care, 27
hospice, outpatient therapy services, congregate meals, home health, 28
or senior wellness clinic, or to reduce to one or two the number of 29
beds per room or to otherwise enhance the quality of life for 30
residents in the nursing home, may convert the original facility or 31
portion of the facility back, and thereby increase the number of 32
nursing home beds to no more than the previously licensed number of 33
nursing home beds without obtaining a certificate of need under this 34
chapter, provided the facility has been in continuous operation and 35
has not been purchased or leased. Any conversion to the original 36
licensed bed capacity, or to any portion thereof, shall comply with 37
the same life and safety code requirements as existed at the time the 38
nursing home voluntarily reduced its licensed beds; unless waivers 39
from such requirements were issued, in which case the converted beds 40
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shall reflect the conditions or standards that then existed pursuant 1
to the approved waivers. 2
(b) To convert beds back to nursing home beds under this 3
subsection, the nursing home must: 4
(i) Give notice of its intent to preserve conversion options to 5
the department of health no later than 30 days after the effective 6
date of the license reduction; and 7
(ii) Give notice to the department of health and to the 8
department of social and health services of the intent to convert 9
beds back. If construction is required for the conversion of beds 10
back, the notice of intent to convert beds back must be given, at a 11
minimum, one year prior to the effective date of license modification 12
reflecting the restored beds; otherwise, the notice must be given a 13
minimum of 90 days prior to the effective date of license 14
modification reflecting the restored beds. Prior to any license 15
modification to convert beds back to nursing home beds under this 16
section, the licensee must demonstrate that the nursing home meets 17
the certificate of need exemption requirements of this section.18
The term "construction," as used in (b)(ii) of this subsection, 19
is limited to those projects that are expected to equal or exceed the 20
expenditure minimum amount, as determined under this chapter.21
(c) Conversion of beds back under this subsection must be 22
completed no later than four years after the effective date of the 23
license reduction. However, for good cause shown, the four-year 24
period for conversion may be extended by the department of health for 25
one additional four-year period. 26
(d) Nursing home beds that have been voluntarily reduced under 27
this section shall be counted as available nursing home beds for the 28
purpose of evaluating need under RCW 70.38.115(2) (a) and (k) so long 29
as the facility retains the ability to convert them back to nursing 30
home use under the terms of this section. 31
(e) When a building owner has secured an interest in the nursing 32
home beds, which are intended to be voluntarily reduced by the 33
licensee under (a) of this subsection, the applicant shall provide 34
the department with a written statement indicating the building 35
owner's approval of the bed reduction. 36
(10)(a) The department shall not require a certificate of need 37
for a hospice agency if: 38
(i) The hospice agency is designed to serve the unique religious 39
or cultural needs of a religious group or an ethnic minority and 40
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commits to furnishing hospice services in a manner specifically aimed 1
at meeting the unique religious or cultural needs of the religious 2
group or ethnic minority; 3
(ii) The hospice agency is operated by an organization that:4
(A) Operates a facility, or group of facilities, that offers a 5
comprehensive continuum of long-term care services, including, at a 6
minimum, a licensed, medicare-certified nursing home, assisted 7
living, independent living, day health, and various community-based 8
support services, designed to meet the unique social, cultural, and 9
religious needs of a specific cultural and ethnic minority group;10
(B) Has operated the facility or group of facilities for at least 11
10 continuous years prior to the establishment of the hospice agency;12
(iii) The hospice agency commits to coordinating with existing 13
hospice programs in its community when appropriate;14
(iv) The hospice agency has a census of no more than 40 patients;15
(v) The hospice agency commits to obtaining and maintaining 16
medicare certification; 17
(vi) The hospice agency only serves patients located in the same 18
county as the majority of the long-term care services offered by the 19
organization that operates the agency; and 20
(vii) The hospice agency is not sold or transferred to another 21
agency. 22
(b) The department shall include the patient census for an agency 23
exempted under this subsection (10) in its calculations for future 24
certificate of need applications. 25
(11) To alleviate the need to board psychiatric patients in 26
emergency departments and increase capacity of hospitals to serve 27
individuals on 90-day or 180-day commitment orders, for the period of 28
time from May 5, 2017, through June 30, 2028: 29
(a) The department shall suspend the certificate of need 30
requirement for a hospital licensed under chapter 70.41 RCW that 31
changes the use of licensed beds to increase the number of beds to 32
provide psychiatric services, including involuntary treatment 33
services. A certificate of need exemption under this subsection 34
(11)(a) shall be valid for two years. 35
(b) The department may not require a certificate of need for:36
(i) The addition of beds as described in RCW 70.38.260 (2) and 37
(3); or 38
(ii) The construction, development, or establishment of a 39
behavioral health hospital licensed as an establishment under chapter 40
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71.12 RCW that will have no more than 16 beds and provide treatment 1
to adults on 90 or 180-day involuntary commitment orders, as 2
described in RCW 70.38.260(4). 3
(12)(a) An ambulatory surgical facility is exempt from all 4
certificate of need requirements if the facility: 5
(i) Is an individual or group practice and, if the facility is a 6
group practice, the privilege of using the facility is not extended 7
to physicians outside the group practice; 8
(ii) Operated or received approval to operate, prior to January 9
19, 2018; and 10
(iii) Was exempt from certificate of need requirements prior to 11
January 19, 2018, because the facility either: 12
(A) Was determined to be exempt from certificate of need 13
requirements pursuant to a determination of reviewability issued by 14
the department; or 15
(B) Was a single-specialty endoscopy center in existence prior to 16
January 14, 2003, when the department determined that endoscopy 17
procedures were surgeries for purposes of certificate of need.18
(b) The exemption under this subsection: 19
(i) Applies regardless of future changes of ownership, corporate 20
structure, or affiliations of the individual or group practice as 21
long as the use of the facility remains limited to physicians in the 22
group practice; and 23
(ii) Does not apply to changes in services, specialties, or 24
number of operating rooms. 25
(13) A rural health clinic providing health services in a home 26
health shortage area as declared by the department pursuant to 42 27
C.F.R. Sec. 405.2416 is not subject to certificate of need review 28
under this chapter. 29
(14) Hospital at-home services, as defined in RCW 70.41.550, are 30
not subject to certificate of need review under this chapter.31
(15) Elective percutaneous coronary interventions provided at 32
hospitals accredited as a comprehensive heart attack center or 33
primary heart attack center or categorized as a level one or level 34
two cardiac center in the Washington state emergency cardiac and 35
stroke system, shall not require a certificate of need for these 36
services.37
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