Washington
Washington requires CONs within five broad categories—hospital beds, beds outside hospitals, equipment, facilities and services. Although most healthcare facilities in Washington only require a CON when they are first constructed, nursing homes must obtain a CON for any renovations or alterations that will cost more than $2,834,165, as updated annually. See Wash. Rev. Code § 70.38.105(4)(d).
Washington’s COVID-19 Response
On March 30, 2020, Governor Inslee suspended CON requirements for nursing homes and assisted living facilities to provide surge capacity for the state’s COVID-19 response. Wash. Proclamation 20-38 (Mar. 30, 2020); see also Wash. Procs. 20-38.2 (May 11, 2020), 20-38.3 (May 29, 2020) (extending CON suspension through June 17, 2020). After the expiration of the temporary suspension, healthcare facilities must stop operating at surge capacity or apply for a full CON to continue using additional beds.
Application Process
In Washington, the CON application process takes between 15 and 135 days. Wash. Admin. Code §§ 246-310-120(2)(c)(ii), -140(1), -160(1). There are rolling applications for regular and expedited review. See General Timelines for Certificate of Need Application. The fee for a CON application depends on the project type, and can range from $770 to $46,253. Wash. Admin. Code § 246-310-990. Competitors can intervene in the application process and can offer “reasonable questioning” during a public hearing as to why an application should be denied. Wash. Admin. Code § 246-310-180(5).
Types of CONs in Washington
| CON? | CON required when expenditure exceeds: | Temporary COVID-19 response: | |
| Hospital Beds | Yes | Any amount | - |
| Beds Outside Hospitals | Yes | Any amount | Suspended |
| Equipment | Yes | Any amount | – |
| Facilities/Buildings | Yes | $0 – $2,834,165+ | – |
| Services | Yes | Any amount | – |
| Emergency Medical Transport | No | – | – |
Washington CONs in Detail
| Category | Types of CONs | Citation |
| Hospital Beds | Hospital beds. Psychiatric hospital beds. | Wash. Rev. Code §§ 70.38.025(6), 70.38.105(4)(e) |
| Beds Outside Hospitals | Acute care beds. Assisted living facility care beds. | Wash. Admin. Code § 246-310-020(1)(c) |
| Hospice beds. Hospice care center beds. Nursing home beds. Kidney disease treatment center beds. Ambulatory surgical facility beds. | Wash. Rev. Code §§ 70.38.025(6), 70.38.105(4)(e) | |
| Equipment | Any increase in the number of dialysis stations in a kidney disease center. | Wash. Rev. Code § 70.38.105(4)(h) |
| Facilities/Buildings | Hospices. Hospice care centers. Hospitals. Psychiatric hospitals. Nursing homes. Kidney disease treatment centers. Ambulatory surgical facilities. | Wash. Rev. Code §§ 70.38.105(4)(a)-(b), § 70.38.025(6) |
| Any capital expenditure for construction, renovation, or alteration of a nursing home which substantially changes the services of the facility. | Wash. Rev. Code § 70.38.105(4)(c) | |
| Any capital expenditure for construction, renovation, or alteration of a nursing home that exceeds $2,834,165, as updated annually. | Wash. Rev. Code § 70.38.105(4)(d); see also Wash. Dep’t of Health, Nursing Home Capital Expenditure Minimum Dollar Threshold for Nursing Home Projects (2019–20)76 | |
| Services | Specialty burn services. | Wash. Admin. Code § 246-310-020(1)(d)(i)(A) |
| Intermediate care nursery and/or obstetric services level II. | Wash. Admin. Code § 246-310-020(1)(d)(i)(B) | |
| Neonatal intensive care nursery and/or obstetric services level III. | Wash. Admin. Code § 246-310-020(1)(d)(i)(C) | |
| Home health agencies. | Wash. Rev. Code §§ 70.38.105(4)(c), 70.38.025(6) | |
| Category | Types of CONs | Citation |
| Services | Organ transplantation services (service for each separate organ is a separate tertiary service). | Wash. Admin. Code § 246-310-020(1)(d)(i)(D) |
| Open heart surgery and/or elective therapeutic cardiac catheterization including elective percutaneous transluminal coronary angioplasty. | Wash. Admin. Code § 246-310-020(1)(d)(i)(E) | |
| Inpatient physical rehabilitation services level I. | Wash. Admin. Code § 246-310-020(1)(d)(i)(F) | |
| Specialized inpatient pediatric services. | Wash. Admin. Code § 246-310-020(1)(d)(i)(G) | |
| Emergency Medical Transport | No CONs in this category. |
Washington CON Exceptions
| No CON Required For: | Citation |
| Construction, development or other establishment of a nursing home, or the addition of beds to an existing nursing home, that is owned and operated by a continuing care retirement community. | Wash. Rev. Code § 70.38.111(5); Wash. Admin. Code § 246-310-041(1) |
| Reestablishment of previously reduced bed capacity by a rural hospital or rural health care facility. | Wash. Rev. Code § 70.38.111(6), (8); Wash. Admin. Code § 246-310-042(1) |
| Application by a rural health facility, formerly licensed as a hospital, for a hospital license with no increase or redistribution in bed capacity. | Wash. Code Rev. § 70.38.111(7) |
| Reestablishment of previously reduced nursing home beds. | Wash. Rev. Code § 70.38.111(9); Wash. Admin. Code § 246-310-043 |
| Replacing of existing nursing home beds by a nursing home. | Wash. Rev. Code § 70.38.115(13); Wash. Admin. Code § 246-310-044(1) |
| A change in bed capacity at a residential hospice care center. | Wash. Rev. Code § 70.38.111(10); Wash. Admin. Code § 246-310-045 (1) |
| Offering an inpatient tertiary health service by a health maintenance organization if: The organization (or the service area) has an enrollment of at least 50,000 individuals; The facility is reasonably accessible to such enrolled individuals; and At least 75% of the patients who will receive the service are enrolled with such organization. | Wash. Rev. Code § 70.38.111(1)(a) |
| A health care facility if: It primarily provides (or will provide) inpatient health services; The facility (or the service area) has an enrollment of at least 50,000 individuals; The facility is reasonably accessible to such enrolled individuals; and At least 75% of the patients who will receive the service are enrolled with such organization. | Wash. Rev. Code § 70.38.111(1)(b) |
| A health care facility if: The facility will be, or is, leased by a health maintenance organization which has, or the service area of the organizations has, an enrollment of 50,000 individuals; At least 15 years remain on the lease; The facility is or will be geographically located so that the service is reasonably accessible to such individuals; and At least 75% of the patients will be enrolled in such organizations. | Wash. Rev. Code § 70.38.111(1)(c) |
| Psychiatric beds in hospitals, until June 30, 2021. | Wash. Rev. Code § 70.38.111(11) |
| Grandfathered, physician-owned ambulatory surgical facilities. | Wash. Rev. Code § 70.38.111(12) |
| A rural health clinic providing health services in a home health shortage area as declared by the department pursuant to 42 C.F.R. Sec. 405.2416. | Wash. Rev. Code § 70.38.111(13) |