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. 405.2416Wash. Rev. Code § 70.38.111(13)