Washington requires CONs within four broad categories—hospital beds, beds outside hospitals, facilities and services. Washington maintains 27 specific CON requirements. Like nine other states, Washington excludes equipment from its CON program. 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).

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 90 days. Wash. Admin. Code §§ 246-310-140(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).

CON? Number of CONs Moratoria Temporary COVID-19 response:
Hospital Beds Yes 2 No action
Beds Outside Hospitals Yes 6 Suspended at least some CON laws
Equipment No
Facilities/ Buildings Yes 8 No action
Services Yes 11 No action
Emergency Medical Transport No

Note: these citations are accurate as of May 2020.

Washington CONs in Detail


Types of CONs


Hospital Beds

1.Hospital beds.  

2.Psychiatric hospital beds.  

Wash. Rev. Code § 70.38.025(6)  

Beds Outside Hospitals

1.Acute care beds. 

2.Assisted living facility care beds.  

Wash. Admin. Code § 246-310-020(1)(c)  

3.Hospice beds.  

4.Nursing home beds.  

5.Kidney disease treatment center beds.  

6.Ambulatory surgical facility beds.  

Wash. Rev. Code §§ 70.38.025(6),



No CONs in this category.



2.Hospice care centers.


4.Psychiatric hospitals.

5.Nursing homes.

6.Kidney disease treatment centers.

7.Ambulatory surgical facilities.

Wash. Rev. Code §§ 70.38.105(4)(c),

§ 70.38.025(6)

8.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)79


1.Specialty burn services.  

Wash. Admin. Code § 246-310-020(1)(d)(i)(A)  

2.Intermediate care nursery and/or obstetric services level II.  

Wash. Admin. Code § 246-310-020(1)(d)(i)(B)  

3.Neonatal intensive care nursery and/or obstetric services level III. 

Wash. Admin. Code § 246-310-020(1)(d)(i)(C)  

4.Home health agencies.

Wash. Rev. Code §§ 70.38.105(4)(c), 70.38.025(6) 


Types of CONs



5.Organ transplantation services (service for each separate organ is a separate tertiary service).

Wash. Admin. Code § 246-310-020(1)(d)(i)(D)  

6.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)  

7.Inpatient physical rehabilitation services level I.

Wash. Admin. Code § 246-310-020(1)(d)(i)(F)  

8.Specialized inpatient pediatric services.

Wash. Admin. Code § 246-310-020(1)(d)(i)(G)  

9.Alcoholism services.

10.Drug abuse services.

11.Mental health services.

Wash. Rev. Code § 70.38.025(8)  

Emergency Medical Transport  

No CONs in this category.

Washington CON Exceptions

No CON Required For:  


1.Expansion of the number of CON-approved operating rooms.  

Wash. Admin. Code § 246-310-020(1)(iii)  

2.Offering an inpatient institutional health service, the acquisition of major medical equipment for the provision of an institutional health service, or the obligation of a capital expenditure in excess of the expenditure minimum for the provision of an inpatient institutional health service.  

Wash. Admin. Code § 246-310-040  

3.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. Admin. Code § 246-310-041(1)  

4.Increasing the bed capacity in a rural hospital.  

Wash. Admin. Code § 246-310-042(1)  

5.Replacing of existing nursing home beds by a nursing home.  

Wash. Admin. Code § 246-310-044(1)  

6.A change in bed capacity at a residential hospice care center.  

Wash. Admin. Code § 246-310-045 1)  

7.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)  

8.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)  

9.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)