Overview of Construction Review Services

Expected Submission Review Time is 75 days (More about our timeline)

What does this mean for my project? For planning purposes it’s important to understand that this estimate of review time is not the time it takes to review an entire project or receive a facility license.  A “submission” means a distinct set of information (typically plans, specifications, programs, etc.) given to construction review to analyze for compliance with state rules. After a submission is reviewed, there will often be comments that must be responded to and drawings that must be revised. After your design team revises plans and responds to comments, they submit those revisions as a new "submission." A project will often take several submissions to complete.

The number above is a rough estimate for an average submission. Submissions for larger projects will take longer. The construction review program experiences significant shifts in workload and bandwidth, so it’s always best to contact your assigned plan reviewer to get a more accurate read on how long a particular review may take.


Construction Review is part of the overall licensing process. Our focus is to ensure that the physical environment meets state and national standards by working with owners and design teams throughout the design process. If we identify compliance issues early in the design, facilities and designers can resolve them more quickly with less resources. 

This page contains resources intended to help you understand the process of construction review and where it fits with overall licensure.

There are often several steps you must complete to become licensed. Construction review is not the only step. We encourage you to connect with licensing program representatives to determine what is required for each license type. 

Often a facility may require multiple types of licenses such as a hospital that also has a DOH licensed pharmacy or a nursing home that also has a DOH license medical test site.

In addition to the licensing links above, we are including links to several other license and review process that may be helpful. This list is not exhaustive, but represents several common concurrent review processes.

Certificate of Need

Some projects may require you to obtain a Certificate of Need (CN). The Certificate of Need program  is a regulatory process that requires certain healthcare providers to obtain state approval before building certain types of facilities or offering new or expanded services. This requires a separate application and review. The CN and CRS projects can be reviewed at the same time. We strongly encourage contacting the CN program to determine if a review is required. We may hold our authorization to begin construction until a CN approval is received.

Radiation protection review

Project that contains radiation emitting devices may require review of physicist calculations through the Office of Radiation protection. This requires a separate application and review. Radiation protection projects and CRS projects can be reviewed at the same time. CRS is will often ask if you have received approval from radiation protection.

Pharmacy license review

Pharmacies within health care facilities will typically require separate licensure as a pharmacy. This requires a separate application and review. Pharmacy license and CRS projects can be reviewed at the same time.

Medical test site review

Medical test sites (MTS) within health care facilities will typically require separate licensure as a medical test site. This requires a separate application and review. MTS license and CRS projects can be reviewed at the same time. 

Technical Assistance

Construction review provide a wide range of technical assistance opportunities. These take different forms, but the most common form is the technical assistance conference. This is a face to face or virtual meeting to review the scope of the project, determine applicable rules and compare those rules with a design or building. In our experience, the need for technical assistance increases with the size and complexity of the project – but we are always available. The following are some common interactions that may prove helpful to your project.

Preliminary design

A preliminary review addresses questions on project scope and process. This is particularly encouraged for those that have not recently been involved with licensed healthcare projects in Washington State. Preliminary plan review conference goals include assistance with:

  • Feasibility of a building or project
  • Determining the appropriate plan review fee
  • Determining applicable licensing requirements
  • Development of the functional program
  • Interpretation of specific regulations that significantly impact the project
Design development review

During the creation of design development documents, a conference is helpful to review the main project elements. At this point, the functional program should be sufficiently established so that the planned operations can be compared with the major components required by code. Identification of non-compliant elements will save costly redesign during construction documentation. Design development review goals include assessment of:

  • Scope of services provided
  • Size and capacity of rooms
  • Number, location, and type of support spaces
  • Any known compliance issues/ alternative proposals
Construction document review

As the construction documents near completion, a conference is helpful to review final details and prepare for plan review submission. It's also a good time to validate how questions from previous conferences have been addressed. If no previous conferences have occurred, we will identify as many high priority issues in the time left before plan review. Goals include:

  • Address final design details
  • Prepare for plan review
  • Provide updates on alternative method requests
  • Identify/recommend cost saving measures
Plan review intake

We recommend that large and complex projects have a short intake conference at the point where you submit your construction documents for plan review. This helps orient the plan review team to the documents and speeds up the plan review process.

Post plan review

For large and complex projects, or projects with significant comments, a short meeting to  review the initial plan review comments can be helpful. This conference helps to ensure that everyone understands what the comment is about and how best to quickly resolve it.


The definitions in this section apply throughout this chapter unless the context clearly indicates otherwise.


Facilities that must be certified to participate in Medicare or Medicaid programs and meet physical environment minimum standards as required in the Code of Federal Regulations.

Change of approved use only

A change in the function of a room that does not alter the physical elements.


"Finishes" includes, but is not limited to, products such as carpet, vinyl wall covering, wall paper, exterior siding, landscaping or paneling applied to an existing surface as the exposed surface.


Facilities licensed from the state Department of Health or state Department


 A recommendation to the licensing or certifying authority from construction review services indicating that a facility meets the physical environment rules and the plan review process is complete.


Washington State Department of Health, Construction Review Services.


A change to a facility including new construction, replacement, alterations, additions, expansions, conversions, change of approved use, improvements, remodeling, renovating and upgrading of the following types of facilities:

  • "Ambulatory surgery center" defined as a facility that is required to be certified for participation in Medicare or Medicaid or ambulatory surgical facilities licensed under chapters 70.230 RCW and 246-330 WAC
  • "Birthing centers" (formerly maternity homes) and "childbirth centers" licensed under chapters 18.46 RCW and 246-329 WAC
  • "Assisted living facility" (formerly boarding homes) licensed under chapters 8.20 RCW and 388-78A WAC
  • "Correctional facilities" as defined under RCW 43.70.130(8)
  • "Hospice care center" licensed under chapters 70.127 RCW and 246-335 WAC
  • "Hospitals" licensed under chapters 70.41 RCW and 246-320 WAC
  • "Nursing homes" licensed under chapters 18.51 RCW and 388-97 WAC
  • "Private alcohol and chemical dependency hospitals" licensed under chapters 71.12 RCW and 246-324 WAC
  • "Private psychiatric and alcoholism hospitals" licensed under chapters 71.12 RCW and 246-322 WAC
  • "Residential treatment facilities" licensed under chapters 71.12 RCW and 246-337 WAC
  • "Temporary worker housing" licensed under chapters 70.114A RCW and 246-358 WAC
Project cost

All costs directly associated with the project, initially estimated and corrected by certification to the date of completion of the project and including all fixed and installed clinical equipment in the project and contractor supervision, inspection and overhead. This cost does not include:

  • Taxes
  • Architectural or engineering fees
  • Land acquisition fees
Project sponsor

The person, persons or organization, planning and contracting for the design and construction of facilities, generally the owner or the owner's representative.

Technical assistance

Assistance provided by the program to facilities either at the program offices or at the project location including:

  • Information on the laws, rules and compliance methods and technologies applicable to the regulations.
  • Information on methods to avoid compliance problems.
  • Assistance in applying for permits, licensure or certification.
  • Information on the mission, goals, and objectives of the program.
  • Assistance to parties constructing projects not required to be licensed or certified and voluntarily wish to comply with rules or guidelines in the interest of safety or best practices.
Value of existing construction

The value of an existing building or portion thereof at the time of project submission, based on the current market value of the structure as documented by the project sponsor, or, as determined by assigning a cost per square foot value.

Frequently Asked Questions

If the local building official has already reviewed and approved my plans for construction, why does Construction Review Services need to look at my plans?

The local building official and Construction Review Services (CRS) review the project for different requirements. While the local building official has the authority over occupancy of the building, CRS reviews the plans to ensure that the licensing and Medicare certification requirements have been met. The licensing requirements include physical plant requirements and are specific to the intended services.

When I change the use of a room, do I need to contact Construction Review Services?

Yes, a simple alteration of use may create hazards for building occupants. We encourage you to contact CRS and discuss your ideas before you make the change. If the modification does not pose a hazard to the occupants, CRS will determine that a project is not required. If a change of use creates a hazard, CRS staff can give you guidance on economical ways to meet the rules. If the changes don't require any construction, the plan review fee is based on a flat fee for finishes only.

Do I need to hire an architect?

It depends on the project. Smaller projects that do not have any structural changes and are considered "minor alterations" can be submitted directly to CRS for review. CRS could also schedule a site visit to look at your project and potentially approve it in the field. You will need to check with your local building department to determine if they require an architect. In most instances projects that do not require submittal to the local building department do not require an architect when submitted to Construction Review Services.

Who else needs to review my plans?

The local building department will most likely need to review the project. You must contact your local building department to determine what is reviewable. You may find the contact information for your local building department on Washington Association of Building Officials' website.

How long will my plan review take?

We try our best to complete all plan reviews within 32 days. The length of time plan review takes greatly depends on the thoroughness of the plans and documents and the responsiveness of your consultants.  There are times when the program experiences heavy workloads.  We include a current estimation of plan review time at the top of our main webpage.

Does my outpatient clinic have to meet the same requirements as my hospital?

Outpatient clinics can be included under your hospital license in which case they must follow the Hospital Licensing Regulations (Chapter 246-320 WAC)  for outpatient facilities. These clinics must be included when you bill for services under your hospital's Center for Medicaid and Medicare provider number.

What editions of the codes do you use when reviewing my plans?

The licensing regulations require facilities to meet the codes as adopted by the State Building Code Council, the requirements of the Centers for Medicare & Medicaid Services, and the current licensing guidelines. Our licensing regulations take a scaled approach to actual physical requirements. Safety features are risk-based and many outpatient facilities don't have to meet the same technical requirements as hospitals.

How is the Centers for Medicare & Medicaid Services involved in the process?

Construction Review Services reviews the plans for conformance with the federal requirements. The codes and standards adopted by the federal government can be found in the federal register. Please see Part 482-Conditions of Participation for Hospitals that explains what physical plant standards must meet for Medicare/Medicaid certification. In Washington, you must meet these standards as part of the licensing requirements.

The Centers for Medicare & Medicaid Services has adopted the 2012 edition of NFPA 101, Life Safety Code and the 2012 edition of NFPA 99, the Health Facilities Code. What editions of other referenced NFPA documents are required?

Each of the adopted standards contain a list of referenced publications, included within the edition, that are required to be in compliance with the base code. In the case of National Fire Protection Association (NFPA) 110, the 2012 edition is required. 

More Resources

Applying to CRS | Applications | Certificate of Need (CoN) | Desk Reference Manuals | Local AHJ (courtesy of WABO) | Plan Review Fee | Facilities Reviewed by CRS