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CON Services / Washington Certificate of Need Program (CON)

Certificate of Need (CON) Overview

Contact Us for more information about the Washington Certificate of Need Process (CON), or call 512-371-8166

Washington CONLike many other states, Washington has an extensive CON process in place for healthcare services and facilities. Winning approval for a CON application is often a time consuming and difficult undertaking. Working with RPC provides clients with a team of consultants with experience working with CON projects.

When working on a CON project, RPC can prepare the entire CON application or sections of the application as the client prefers. When the client is defining the project and deciding whether to file an application, RPC can help assess the market and regulatory situation to determine the relative likelihood of success for a project. RPC not only works to create a thorough market, need and financial analysis, but also works seamlessly with the client’s staff, architects, engineers and, other outside consultants to create a solid CON application.

RPC is led by Ron Luke, JD, PhD, who has prepared CON applications and presented testimony in CON hearings since 1981 in more than 20 states.  RPC’s work on CON projects includes the opening of new acute care hospitals, hospices, physical rehabilitation and psychiatric specialty hospitals, and nursing homes, the relocation and addition of beds, and the acquisition of major medical equipment. Working with RPC during the CON process gives the applicant the advantage of a skilled expert team that can provide expert advice and produce an effective CON application.

State Agencies

Washington Certificate of Need ProgramSecretary of the Washington State Department of Health
The secretary or the secretary’s designee renders the final decisions in the review process.

 

Certificate of Need program staff
The staff currently consists of 1 program manager and 3 analysts.  The staff screens, reviews, and prepares written analysis on applications. The staff is also able to provide technical assistance before CON applications are submitted.

Department of Health
Certificate of Need Program
P O Box 47852
Olympia, Washington 98504-7852
(360) 236-2955

Services that Require CON

The Washington State Certificate of Need program is a regulatory process that requires certain health care providers to obtain state approval before building certain types of facilities or offering new or expanded services.  The CON process is intended to help ensure that facilities and new services proposed by health care providers are needed for quality patient care within a particular region or community.  CON review is required for:

  • Construction, development, or establishment of a:
    • Hospital
    • Nursing home
    • Kidney dialysis center
    • Medicare or Medicaid home health agency
    • Medicare or Medicaid hospice agency
    • Ambulatory surgical center
    • Hospice care center
  • Increases in the number of stations at a kidney dialysis center
  • Sale, purchase, or lease of an existing hospital
  • Increases in the number of licensed beds at a hospital, nursing home, or hospice care center
  • Offering a new tertiary health service, including:
    • Level I rehabilitation programs
    • Open heart surgery
    • Therapeutic cardiac catheterization
    • Organ transplantation
    • Specialty burn services
    • Intermediate care nursery and/or obstetric services
    • Level II neonatal intensive care nursery and/or obstetric services
    • Level III specialized inpatient pediatric services
  • An annual capital expenditure made by a nursing home exceeding $1,000,000 (adjusted for inflation, the 2012 minimum is $2,403,990)
  • Nursing home bed banking transactions
  • Nursing home replacements

Certificate of Need Process Milestones

There are four different types of review: regular, concurrent (competing applications), emergency, and expedited.  Concurrent applications are submitted at specific times throughout a year while the other types of applications may be submitted at any time.  According to WAC § 246-310-120-130, some projects, including those involving nursing home beds and open heart surgery, must be submitted for concurrent review. Regardless of the type of review, all applicants must submit a letter of intent, then an application with fee. Timing of the letter of intent and submission of the application may vary depending on the type of review. For a regular review, the applicant follows the process described below. 

  1. Letter of Intent
  2. The applicant files a letter of intent (LOI) with the department a minimum of 30 days prior to filing an application.  To be valid, the LOI must include a project description, cost estimation, and identification of the service area.  It is valid for 6 months.

  3. Submission and Screening
  4. The application may be submitted from the 31st day after the LOI is submitted up to 6 months.  Once submitted, staff begins screening the application.  Within 15 working days, the staff determines if the application is complete.  If it is not, staff will solicit the applicant for additional information.

  5. Applicant Response
  6. The applicant can respond with the requested information within 45 days of the request, not respond, or submit the requested information and ask for another screening. If the applicant has not submitted all materials required to make their application complete by the 120th day after the first screening period, the application will be returned to the applicant.

  7. Formal Review (90 days)
  8. The formal review period begins the 5th working day after the department declares the application complete.  The first 45 days are dedicated to public comment.  The last 45 days are reserved for analysis and decision-making. 

  9. Public Hearing and Public Comment Period
  10. The public comment period is limited to 45 days. The fist 35 days of the public comment period are reserved for receiving public comments and conducting a public hearing, if requested. The remaining 10 days of the public comment period are reserved for the applicant’s rebuttal statements to comments received. . A hearing request must be submitted in writing within 15 days of the beginning of review notification, and written notice to the general public must be submitted in a newspaper of general circulation in the applicant’s proposed service area. Written notice of the hearing is sent to the applicant, affected persons, the interested person, and posted on the CON program’s website.

  11. Decision
  12. The department will complete its final review and the secretary’s designee will make a decision on the CON application within 45 days of the end of the public comment period.

  13. Reconsideration
  14. The applicant and any interested or affected person may request a public hearing for the reconsideration of the decision of the secretary's designee. The department shall conduct a reconsideration hearing if it finds the request is written, is received within 28 days of department’s decision, states grounds for good cause (new relevant information, significant changes in circumstances, evidence of material failure on part of the department to follow procedures), and has the signature of person making request. The hearing is scheduled within 30 days of approval for reconsideration. Notice is sent to the person requesting the hearing, the applicant, interested and affected persons, published in the local newspaper, and posted on the Program’s website. The department will release written findings stating the basis of their reconsideration decision within 45 days after the conclusion of the reconsideration hearing.

  15. Appeal Process
  16. Within 28 days of the department’s decision or reconsideration decision, the applicant or any affected person may file for an adjudicative proceeding with the Adjudicative Clerk Office in Olympia. Notice is sent to the applicant, interested, and affected persons who participated in the review process. These institutions are invited to present oral and written testimony.

What criteria are used to review a CON?

Detailed criteria are published in the Washington Administrative Code, and some numeric need methodologies are published on the CON website. As presented in WAC § 246-310-200, the bases for findings and action on applications that the department reviews are based on:

  • Need of the population served/to be served for the proposed services
  • Whether the project will foster cost containment
  • The project’s financial feasibility
  • Structure and process [quality] of care is reviewed for consistency with service and facility standards, any applicable long-range plans, federal standards, licensing requirements, staffing requirements and other applicable standards

Certificate of Need Application Filing Fee

The applicant pays a fee based on the facility type.  If an applicant proposes two separate projects, then two separate applications must be submitted, each with the appropriate review fee.  Fees range from $770 (for bed banking extensions) to $46,253 for nursing homes.  The full schedule can be found in WAC 246-310-990.

Additional Sources

(links good as of October 2013)

Washington State Department of Health, Certificate of Need
http://www.doh.wa.gov/LicensesPermitsandCertificates/FacilitiesNewReneworUpdate/CertificateofNeed.aspx

CON Statute
http://apps.leg.wa.gov/RCW/default.aspx?cite=70.38

CON Rules
http://apps.leg.wa.gov/wac/default.aspx?cite=246-310

CON Application Forms
http://www.doh.wa.gov/LicensesPermitsandCertificates/FacilitiesNewReneworUpdate/CertificateofNeed/ApplicationForms.aspx

General Timelines for CON Applications
http://www.doh.wa.gov/LicensesPermitsandCertificates/FacilitiesNewReneworUpdate/CertificateofNeed/ReviewProcess.aspx

Numeric Need Methodologies
http://www.doh.wa.gov/LicensesPermitsandCertificates/FacilitiesNewReneworUpdate/CertificateofNeed/NeedMethodologies.aspx

Contact RPC Consulting
Should you or your client need an expert team to help you with the Washington Certificate of Need Process (CON), please contact Dr. Ron Luke at 512-371-8166.

6300 La Calma Drive, Suite 170 Austin, Texas 78752 | (512) 371-8000 | www.rpcconsulting.com

Disclaimer: The information on this page has been compiled by RPC in June 2010 based on sources believed to be reliable. It was updated in February 2014. Where possible we have had the material reviewed by state CON officials or others knowledgeable of the state’s CON program. The information is not offered as legal advice. A state may change its rules, forms and procedures at any time and RPC offers no assurance that the information will be correct on the date it is viewed. Therefore the reader is urged to use this information only as a starting point for any CON application and to speak with state officials or seek legal or consulting advice early in the process.