Staffing
- Why is this happening?
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Since 2020, application submissions have continued to decline which has resulted in less 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?
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While the program will make every effort to continue to release evaluations on time, due to the reduced staffing of the program, it is possible that evaluations may be late. We will continue to evaluate our completion timelines and will provide advanced notice should an evaluation be at risk of being late.
- What is the program doing to address this problem?
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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?
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While we will make every effort to mitigate impacts to our customers, you may see the following impacts:
- Longer response times to calls or emails.
- Redirecting requests for technical assistance meetings to our new online request form.
- General TA requests will now be limited to Tuesday and Thursday afternoons. Project specific TAs will continue to be scheduled at the discretion of the assigned analyst.
- Longer wait times for data requests.
- Will these reductions slow down or stop the program's rulemaking or proviso work?
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Due to limited resources, rulemaking may slow down, but we have every intention of continuing to modernize the CN program's regulations in partnership with our community. Proviso work will not be impacted by these changes, and timelines will continue as planned.
- Who should we contact if we have additional questions?
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You can direct questions to:
Eric Hernandez, CN program manager
eric.hernandez@doh.wa.gov
or
Ross Valore, CN executive director
ross.valore@doh.wa.gov
Processes
- Deadlines, what is the latest time I can submit information to the CN Program as part of my application/fees/data submission?
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Submit all application materials by email to the CN program. Materials that have a submission deadline must be received by 11:59 p.m. PST on the day it is due. For example, if you are required to submit your application by March 1, the CN Program must receive your application in our email inbox no later than 11:59 p.m. PST on March 1.
- I have been approached by an advocacy group that has indicated they want additional information included in our application materials submitted to the CN Program. How do I include this information?
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Entities outside of the CN Program cannot compel applicants to submit information that is not specifically required by current CN statutes and rules. All required materials for a CN evaluation requested on our application forms, or screening questions from a CN analyst, or upon recommendation by the CN Program through a technical assistance call. While you may add any information you think will be beneficial to your application materials there are some timeline limitations:
- Once in screening, you can only supplement your application by providing information that was requested by a screening question.
- Direct response to screening questions may be submitted up to ten calendar (10) days after the BOR.
- 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 information outside of this process, could be considered new information which circumvents the public comment period and is viewed as an applicant inappropriately supplementing their application materials, which could jeopardize an application’s approval. If you are unsure whether you are appropriately submitting information, you may email the CN program to ask for clarification.
- What is a letter of intent and what should it include?
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Per Washington Administrative Code 246-310-080, a letter of intent needs to 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?
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A scheduled concurrent review cycle is a regularly planned time for examining proposals that allows the CN Program to determine the best proposed projects for the affected residents in the planning area by comparing similar projects to one another. Scheduled concurrent review cycles are outlined in the rules and are done for CN review of kidney dialysis facilities, hospice agencies, hospice care centers, percutaneous coronary intervention, open heart surgery, and nursing home projects.
For the facility types that do not have a scheduled concurrent review timeline in the rules, an unscheduled concurrent review may still occur. The CN Program will conduct an unscheduled concurrent review when, prior to formal review, more than one application is received for a similar project in the same planning area. In this circumstance, the CN Program will extend the pre-review timelines of the first application received so all potentially competing applications can be reviewed on concurrent timelines.
If an application has been placed under formal review before another application is submitted, the two projects will not undergo an unscheduled concurrent review.
- Do I need to mail a physical copy of my application?
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No. While mailing applications to us is an option, the CN program prefers to have applications submitted electronically.
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 delays the processing of 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 typically correspond with applicants during review of an application?
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Unless an applicant specifically requests to be sent correspondence by US mail, all correspondence, including completed evaluations and associated correspondence during the department's screening and formal review, will be sent electronically to the applicant of record and any additional recipients identified by the applicant. Electronic correspondence is the most efficient use of time and resources for both the CN Program and the applicant.
- I'm an interested/affected person (as defined in WAC 246-310-010) for an application under review. Will the CN Program mail me copies of documents associated with that project?
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No. These documents will be made available to you electronically. The assigned analyst will provide you with a way to access these documents.
- Do I need to provide a copy of my payment when submitting an application?
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No. Please do not include a copy of the check or any banking information in the application. The entire application is a public record and is available to the general public as part of the application materials submitted. 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. The program tracks receipt of payment for projects independently from the applications and applications are only assigned to an analyst once both the application and payment (or payment tracking) are received by the program.
It is recommended to include a copy of the cover of your application with the check. That way the program can quickly connect payments to electronic submissions.
Public Hearings
- What is the purpose of a hearing?
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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 on an issue and then present information to you or the applicant?
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We are currently only conducting public hearings on-line via Microsoft Teams or GoToMeeting. The analyst conducting the meeting will explain how and when attendees can let us know they'd like to speak about the project. If someone wants to give us written comment instead of speaking, they can email it to us by the end of the day of the hearing.
If we do resume in-person hearings, there will be sign-in sheets at the door. The sign-in sheets have two purposes. First, they provide a roster of those attending the hearing. Secondly, they allow people to let us know who wants to speak during the hearing. There is also a spot on the sign-in sheet to let us know if you're in support or opposition of the application so if you don't want to speak you don't have to. However, 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?
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You'll be speaking to department staff. This is usually the analyst assigned to evaluate the application.
- Will the hearing be recorded?
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Yes. All testimony is recorded. Copies are available upon request.
- Will I be able to ask the department and the applicant questions?
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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 only questions that the department will answer are those regarding process.
- How will my comments be used?
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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.
- Are our comments and questions to be addressed by the department later?
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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.
- Must questions and comments be presented in writing?
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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 the say than others. There is no limit to how much written comment someone submits.
- What is the time allotment for each commenter?
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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?
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Public comment period ends at 11:59 p.m. on the day of the hearing. The following 10-working day period (some types of review has 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. 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?
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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?
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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?
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This is an opportunity for anyone to request a consultation with the CN Program.
During these meetings, you may seek assistance and advice about submitting applications, understanding CN regulations, and any other questions they may have about the review process or information that should be included in an application. TAs are scheduled on Tuesday and Thursday afternoons on a first-come-first-served basis.
To request a technical assistance meeting fill out this online form.
- How to be prepared for a technical assistance meeting?
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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 fill out this online form.
Exemptions, also known as Determinations of Reviewability (DORs)
- What is an exemption and why submit one?
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An exemption or determination of reviewability is a formal process to determine if your proposed project requires a CN review before the project is started or implemented.
Timing Exemptions typically take less time than full CN reviews and generally take between 30-60 days. Timing may depend on the responsiveness of applicant.
Fees for exemptions are outlined here.
Forms for some commonly requested exemption types are here.
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.
Fees
- Can I submit my fee payment electronically?
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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 98504-7852When 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.
- When can a fee be refunded?
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In accordance with WAC 246-310-990.
75 percent 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 percent 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.
Complaints
- How do I file a complaint if I believe a health care facility is in violation of Washington CN statutes or rules?
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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 U.S. mail.
Your complaint needs to contain the following:
- Name of the facility believed to be in violation
- Address of the facility
- Reason(s) you believe the facility to be in violation
- Evidence you believe supports the claim of violation(s)
- Your name and contact information (ONLY if you would like the program to keep you informed on the status of your complaint)
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 regular mail to:
Department of Health
Certificate of Need Program
Mail Stop 47852
Olympia, WA 98504-7852
Ambulatory Surgical Facilities / Ambulatory Surgery Centers (ASF/ASC
- Will my surgical facility qualify for an exemption from CN review?
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The only sure way to find out is to submit a determination of reviewability. There is a specific application used for ASF/ASC exemption requests (PDF) posted on our website.
We offer technical assistance (TA) as you complete the application form; see TA discussion above. Once the application form and fee are received by the CN Program, it 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/exemption typically take?
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This process typically takes one to three months. The length of time is dependent on the responsiveness of the applicant.
Nursing homes
- What is the nursing home capital expenditure threshold?
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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 before beginning the project is not required. The capital expenditure threshold amount is adjusted biannually (every other year) to account for inflation. The current amount is specified in this document (PDF).
Utilization Surveys
- What are CN utilization surveys?
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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
- Percutaneous coronary intervention
- Operating rooms
- Acute care beds
- Home health
The surveys are meant to inform CN as to what services are currently available to the public.
- Why are CN utilization surveys important?
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These utilization surveys meant 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?
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See the CN program's Need Methodologies page for current links and schedules for all utilization surveys.
Adjudicative Services
- What are the department's adjudicative services?
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See this department webpage for more information about the department's Adjudicative Service Unit.
- Is there a place to access Adjudicative Services Unit's decisions?