Certificate of Need

Program Overview

The Certificate of Need Program is a regulatory process that requires certain healthcare providers to get state approval before building certain types of facilities, or offering new or expanded services. For example, a certificate of need is required if a hospital wants to add to the number of its licensed beds.

The certificate of need process is intended to help ensure that facilities and new services healthcare providers propose are needed for quality patient care within a particular region or community.

Program staff members are available to provide technical assistance (TA) to you before submitting your application. While TA isn't required, it's highly recommended and can make any required review easier. To request a TA meeting, call 360-236-2955 or email us.

Certificate of Need review is required for

Construction, development or establishment of the following healthcare facilities:
  • Hospitals
  • Nursing homes
  • Kidney dialysis centers
  • Medicare or Medicaid home health agencies
  • Medicare or Medicaid hospice agencies
  • Ambulatory surgical centers
  • Hospice care centers 

Increases in the number of stations at a kidney dialysis center.

Sale, purchase or lease of all or part of an existing hospital, regardless of profit/non-profit status.

Increases in the number of licensed beds at a hospital, nursing home or hospice care center.

Offering a new tertiary health service. These include:
  • 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

Nursing home projects' current capital expenditure threshold is set at a minimum of $2,834,165. Updated December 2019 and established for calendar years 2019 and 2020, Washington Administration Code 246-310-900.

2019-2020 Nursing Home Capital Expenditure (PDF)

Review details are found in chapter 246-310 WAC Certificate of Need.

Certificate of Need and Construction Review Services are distinct review and approval processes. Application requirements differ for each review process. Applicants are encouraged to contact program staff early to avoid unexpected delays. Contact Construction Review staff members for information about their services.

Frequently asked questions

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