Frequently Asked Questions

Program Operations and Staffing

Why are staffing reductions happening?

Since 2020, application submissions have steadily declined, resulting in reduced demand for services. This has, unfortunately, required the program to make the very difficult decision to reduce staffing to align with current workload demands. 

Will the evaluation for my application be late due to the staffing reductions? 

While the program will make every effort to continue to release evaluations on time, reduced staffing may lead to delayed evaluations. We will continue to monitor our completion timelines and will provide advanced notice should an evaluation be at risk of being late. 

What steps is the CN Program taking to address reduced workload and staffing? 

The program is reducing staffing to operate within workload demands. We are continuing to monitor this situation and will take additional steps as needed.  

What other impacts should we expect due to the reduced staffing? 

While we will make every effort to minimize disruption, you may experience:

• Longer response times to calls or emails.
• Redirected technical assistance requests to our online TA request form. 
• Limited general TA availability. Project specific TAs will continue to be scheduled at the discretion of the assigned analyst.   
• Extended wait times for data requests.

Will staffing reductions affect rulemaking? 

Due to limited resources, rulemaking may slow down. however, we intend to continue modernizing the CN Program's regulations in partnership with our community.

Who should we contact if we have additional questions? 

You may direct questions to: 

Eric Hernandez, CN executive director
eric.hernandez@doh.wa.gov

Application Processes and Submissions

Can I submit templates of my policies and/or agreements as part of my application? 

Yes. You may submit templates; however, the CN Program will treat them as drafts. Drafts must still meet minimum requirements for your facility type. If they do not, your application may be suspended, rejected, or denied for lack of completeness.

What is the latest time I can submit materials (application, fees, data) to the CN Program?

All application materials must be submitted by email to the CN Program. Items with a deadline must be received in the CN Program inbox no later than 11:59 p.m. PST on the due date. For example, if an application is due March 1, it must be in the CN inbox by 11:59 p.m. PST on March 1.

How do I submit additional information to my application if requested by an outside group?

Entities outside of the CN Program cannot compel applicants to submit extra information not specified in CN statutes or rules. All required materials are identified in application forms, analyst screening questions, or through technical assistance. While you may include information you believe strengthens your application, there are strict timeline limitations:

1. Once in screening, you can only supplement your application by providing information that was requested by a screening question.
2. Direct response to screening questions may be submitted up to ten calendar (10) days after the beginning of review (BOR).
3. During the public comment period, you may submit information that directly responds to any public comment submitted on your project. You should not provide revised or corrected financial statements or new documents that were not provided in the initial application or response to screening.

Submitting new information outside these steps may be considered inappropriate supplementation, circumventing the public comment period, and could jeopardize approval. When in doubt, email the CN Program to ask for clarification.

What is a letter of intent and what should it include?

A letter of intent (LOI) notifies the CN Program and the community that you plan to submit a project subject to CN review. A letter of intent may be emailed to the CN program.

Per Washington Administrative Code 246-310-080, an LOI must include:

• A description of the services proposed
• The estimated cost of the proposed project
• An identification of the service area

What are unscheduled and scheduled concurrent review?

A scheduled concurrent review cycle is a planned review cycle outlined in rule for certain project types: kidney dialysis facilities, hospice agencies, hospice care centers, percutaneous coronary intervention, open heart surgery, and nursing homes. Scheduled concurrent review cycles allow the CN Program to determine the best proposed projects for the affected residents in the planning area by comparing similar projects to one another. 

An unscheduled concurrent review occurs if, before formal review, more than one application for a similar project is received in the same planning area. In that case, timelines are extended so competing applications can be reviewed together. If an application has already entered formal review, later applications are not considered concurrent.

Do I need to mail a physical copy of my application?

No. While you may mail a physical copy, the CN Program greatly prefers applications submitted electronically as a single PDF.

Applications should be scanned and saved in PDF format and emailed to the CN Program. Do not send your application to individuals within the CN Program, as this will delay processing your application. If the PDF of an application is too large to send by email, the program will provide you with instructions for uploading the application to a file sharing service.

How does the CN Program communicate with applicants during an application review?

Unless an applicant specifically requests to be sent correspondence by US mail, all correspondence (including evaluations, screening questions, and review notices) will be sent electronically to the applicant of record and any designated recipients. 

As an interested or affected person as defined under WAC 246-310-010, how will I receive project documents?

These documents will be made available to you electronically. The assigned analyst will provide you with a way to access these documents.

Should I include proof of payment with my application?

No. Please do not include a copy of the check or any banking information in the application. Applications are public records. The CN Program tracks payments separately and assigns projects only after both application and payment are received. While we make every attempt to redact banking information when we see it in an application, the best approach is to not include it in the application. 

To help link payment to your application, you may include a copy of your application cover sheet with the check.

What is the nursing home capital expenditure threshold?

The nursing home capital expenditure threshold is used to determine whether a nursing home renovation or alteration project requires CN review. If the total costs of the project do not exceed the capital expenditure threshold and do not include renovations of patient care space, then a CN review of the project is not required before beginning the project. The capital expenditure threshold amount is adjusted biannually (every other year) to account for inflation. The current amount is specified in this document (PDF).

What is an exemption (Determination of Reviewability) and why submit one?

An exemption or Determination of Reviewability (DOR) is a formal process to determine if your proposed project requires a CN review before the project is started or implemented.

Timing: Exemption requests typically take less time than full CN reviews, generally between 30 and 60 days, depending on the applicant's responsiveness.

Fees for exemptions are outlined here.

Forms for some commonly requested exemption types are here under the Application Forms heading.

There are several exemptions from CN review, detailed in Revised Code of Washington 70.38.111 and Revised Code of Washington 70.38.260. These were created by the legislature at the public's request often in collaboration with providers and the department.

How do I know if my surgical facility qualifies for an exemption?

The only way to receive a definitive answer is to submit a Determination of Reviewability (DOR). For ASF/ASC exemption requests, a specific application form (PDF) s available on our website. 

We encourage you to request technical assistance (TA) as you complete the form. Once the CN Program receives your completed application and fee, the request will be assigned to an analyst for review.

We also recommend you review determinations we have issued to other facilities to help you understand the information we need and how we evaluate it. Those decisions are available on our website.

How long does a surgery center Determination of Reviewability (DOR)/exemption typically take?

This process typically takes two to six months. The length of time is dependent on the responsiveness of the applicant.

Public Hearings

What is the purpose of a hearing?

The purpose of the hearing is fact finding about the proposed project. We want to know what the people living in the area think about the project.

Do I register to speak? How does it work?

Currently, public hearings are held online via Microsoft Teams or GoToMeeting. The analyst will explain how to indicate that you'd like to speak. If someone wants to provide written comment instead of speaking, they can email it to the CN Program by 11:59 p.m. PST on the day of the hearing.

If in-person hearings resume, a sign-in sheet will be available at the door to register attendees and speakers. You may indicate support or opposition of the project without signing up to speak at the hearing. If you change your mind about speaking, you'll be given an opportunity to speak later in the  hearing. People are called to speak in the order they signed up. The only exception is that we have the spokesperson for the applicant follow the department's opening.

To whom will I be speaking?

You'll be speaking to department staff. This is usually the analyst assigned to evaluate the application.

Will the hearing be recorded?

Yes. All testimony is recorded. Copies are available upon request.

Will I be able to ask the department and the applicant questions?

There is a portion of the hearing set aside for people to ask the applicant questions about the project. The applicant also may ask people who have spoken questions. The purpose of this portion of the hearing is to clarify information presented, not to debate the merits of the proposed project or comments submitted. The department will only answer questions related to process.

How will my comments be used?

Comments received at the hearing will be added to the application materials, along with other information sent to the department during the public comment period. This information is then considered as the evaluation is written.

Your comments, along with other information received by the department, are considered as the department evaluates the application. We don't respond individually to those speaking or submitting written comments.

Do I have to submit comments in writing?

No. You're not required to submit your comments in writing. However, you're encouraged to do so for two reasons: First, each person speaking has a limited amount of time. Second, we recognize some people will have more to share than others. There is no limit to how much written comment someone submits.

What is the time allotment for each commenter?

Each person is limited to three minutes. This limitation is to ensure everyone has a chance to speak that wants to and to be fair to everyone.

What happens after the close of the public hearing?

Public comment period ends at 11:59 p.m. PST on the day of the hearing. The following 10-working day period (some types of review have a longer 30-day period) is for the applicant and those meeting the "affected person" definition in our rules to provide rebuttal comments. These comments may be in response to comments made at the public hearing or received by the department prior to the 11:59 p.m. PST deadline. At the end of this rebuttal period, the department accepts no unsolicited information.

How do I get copies of the written comments and hearing recording?

Anyone may request a copy of the hearing recording, written comments, rebuttal comments and decision. During the review cycle, these documents are available on-line and you will be given access to them on request. After the review cycle has finished, copies should be requested through the agency's public disclosure process.

How do I find out what the decision is?

The written evaluation is due 45 to 75 days following the close of the rebuttal period, depending on the type of project being reviewed. You may make a written request to be sent a copy of the decision when it's released. That request should be mailed to the CN Program.

Technical Assistance (TA)

What is a technical assistance meeting?

A technical assistance (TA) meeting is a consultation with CN staff to help you understand application requirements, regulations, and processes. TAs are scheduled on Tuesday and Thursday afternoons on a first-come-first-served basis.

To request a technical assistance meeting, complete this online form.

How should I prepare for a technical assistance meeting?

The maximum time allowed for a TA meeting is one hour. Exceptions to the one-hour timeline are possible, but rare. For this reason, to make the most effective use of everyone's time, it is important that you submit your questions in advance to the CN Program. This allows CN staff to research answers to your questions and provide you with complete and comprehensive answers.

To request a technical assistance meeting, complete this online form.

Fees

Can I submit my fee payment electronically?

The CN Program does not currently have the capability to accept electronic payments. You will need to submit your fee by U.S. mail or other delivery service (e.g., FedEx, UPS) to:

Department of Health
Certificate of Need Program
Mail Stop 47852
Olympia, WA 98504-7852

When sending your payment, we recommend you send it with a tracking number. The program can use this to demonstrate an applicant's attempt to submit payment before a deadline and it provides assurance to the applicant that their payment was received by the department.

Email the tracking number for the application fee to CN@doh.wa.gov along with the name of your organization and the type of application the payment is intended to cover. 

When can a fee be refunded?

Refund amounts vary under WAC 246-310-990.

75% refund of fees paid: If a CN application is returned by the department for incompleteness, or if an applicant submits a written request to withdraw the CN application before the beginning of review.

50% refund of fees paid: If an applicant submits a written request to withdraw the CN application between the beginning of review and the rebuttal due date.

No refund of fees paid: At any time after the rebuttal due date.

For additional information on how these dates are decided, see WAC 246-310-090 or, if applicable, the corresponding concurrent review schedule.

Utilization Surveys

What are CN utilization surveys?

CN utilization surveys are annual surveys that the CN Program sends out to contacts for licensed facilities or agencies that provide services relevant to the survey topic.

Types of annual surveys are:

• Hospice
• Operating rooms
• Acute care beds
• Home health

Why are CN utilization surveys important?

These utilization surveys are intended to inform CN as to what services are currently available to the public. The survey data is used in CN numeric methodologies to represent these available services. Accurate and updated information is important to keeping our methodologies as precise as possible.

How do I access CN utilization surveys?

See the CN Program's CN Utilization Survey Information section on the Public and Industry Resources page for current links and schedules for all utilization surveys.

Adjudicative Services

What are the department's adjudicative services?

See the Adjudicative Services Office webpage for more information about the department's Adjudicative Services unit. 

Is there a place to access Adjudicative Services Unit's decisions?

See the Adjudicative Service's Significant Decisions webpage to access some of the department's Adjudicative Service Unit's past decisions. 

Complaints

How do I file a complaint if I believe a health care facility is in violation of Washington CN statutes or rules?

If you believe a health care facility may be in violation of RCW 70.38 or WAC 246-310, you may submit your concerns directly to the CN Program via email or US mail. 

Your complaint must contain the following information:

• Name of the facility believed to be in violation
• Address of the facility
• Reason(s) you believe the facility to be in violation
• Evidence supporting the alleged violation(s)
• Your name and contact information (optional - include only if you would like the CN Program to keep you informed about your complaint status)

Be aware the CN Program does not have authority over individual providers. Our authority is limited to health care facilities as defined in RCW 70.38.025(6).

If you would like to submit your complaint anonymously, you may send your complaint via US mail to:

Department of Health
Certificate of Need Program
Mail Stop 47852
Olympia, WA 98504-7852