Applying for a Certificate of Need

The resources below will help guide you through the Certificate of Need (CN) application process. If you need additional assistance, you may request a Technical Assistance meeting with the CN program.

Application Fees

Application Fee Instructions

An application for a Certificate of Need must include payment of a fee as outlined under WAC 246-310-990. Fee payments must include the following:

  • A review fee based on the facility/project type. 
  • A fee for each facility of project type, if multiple types apply.
  • Email the tracking number for the application fee to CN@doh.wa.gov.

Mail the application review fee to:

Department of Health
Certificate of Need Program
PO Box 47852
Olympia, Washington 98504-7852

Application Fees by Facility
Facility Type Review Fee
Ambulatory surgical centers/facilities $20,427
Amendments to issued Certificates of Need $12,874
Emergency review $8,286
Home health agency $24,666
Hospice agency $21,968
Hospice care center $12,874
Hospital (excluding transitional care units (TCUs), ambulatory surgical centers/facilities, home health, hospice and kidney disease treatment centers) $40,470
Kidney disease treatment centers $25,054
Nursing homes (including continuing care retirement communities (CCRCs) and TCUs)) $46,253
Fees for Exemption Requests (nonrefundable fee)
Facility Type Review Fee
Continuing care retirement communities (CCRCs)/health maintenance organizations (HMOs) $8,286
Bed banking/conversions $1,347
Determinations of reviewability $1,925
Hospice care center $1,733
Nursing home replacement/renovation authorizations $1,733
Nursing home capital threshold under RCW 70.38.105(4)(e) (excluding replacement/renovation authorizations) $1,733
Rural hospital/rural healthcare facility $1,733
Fees for Extensions Requests (nonrefundable fee)
Facility Type Review Fee
Bed banking $770
Certificate of Need/replacement/renovation authorization validity period $770
Fees for Amending Pending Applications

Amendment fees for pending Certificate of Need applications are as follows:

  • Adding facility/project types: The review fee for each additional type must be included with the amendment.
  • Removing facility/project types: The department will refund the difference between the original review fee and the new applicable fee.
  • Any other change as identified in WAC 246-310-100: a fee of $2,060 must accompany the amendment application.
Refunds
  • Returned by the department: If an application is returned under WAC 246-310-090 (2)(b) or (e), 75% of review fees will be refunded.
  • Withdrawn before Beginning of Review: If an applicant submits a written request to withdraw an application before the beginning of review process starts, 75% of the review fees will be refunded.
  • Withdrawn after Beginning of Review begins but before the ex parte period: If an applicant withdraws the application during this phase, 50% of the review fees will be refunded.
  • Withdrawn during the ex parte period: If an applicant withdraws the application after the ex parte period starts, no refunds will be issued.

Note: Review fees for exemptions and extensions are nonrefundable.

Application Forms

If you don't see a form for the type of project you are proposing, please email Certificate of Need.

Ambulatory Surgical Facility/Center
End Stage Renal Disease or Kidney Dialysis
Home Health
Hospice
Hospitals
Nursing homes
Additional forms

Need Methodologies

Hospital/Acute Care
Adult Elective Percutaneous Coronary Interventions (PCI)

 If you would like the Excel version of the above methodologies, email the Certificate of Need program.

Two different versions of the methodology were produced using different data sources. One used Clinical Outcomes Assessment Program (COAP) data. The used Comprehensive Hospital Abstract Reporting System (CHARS) data and department outpatient survey results. These data sources are identified in WAC 246-310-745(7).

Hospice
Nursing homes

The current capital expenditure threshold for Nursing Home projects is set at a minimum of $3,865,655. This was updated January 2024 and established for calendar years 2024 and 2025, per Washington Administration Code 246-310-900.

End-stage Renal Disease (ESRD)

Operational Station Report and Timeline Modifications

End-stage Renal Disease Service Area Methodologies

Numeric Need Methodology Regulations

The CN Program determines need according to factors that are variable in relation to the proposed services. These standards are outlined in the Washington Administrative Code, linked below.

CN Utilization Survey Information

CN utilization surveys are used to gather data from existing providers to understand what services are available in each community. This information is critical to developing accurate numeric need methodologies.

Links to Utilization Surveys
Facility Type Survey Start Date Survey Close Date Link to Survey
Hospice April 1 May 1 Hospice Survey
Acute Care Bed July 1 August 1 Acute Care Bed Survey
Operating Rooms (OR) August 1 September 1 OR Survey
Home Health September 1 October 1 Home Health Survey
Percutaneous Coronary Intervention (PCI)     (Discontinued)

General Timeline for Certificate of Need Applications

Review Timeline
Application Activity Regular Review Expedited Review Concurrent Review
Submission of letter of intent Minimum of 30 days prior to applications submission (six-month validity from date of receipt). Minimum of 30 days prior to applications submission (six-month validity from date of receipt). Submitted in conformance with published schedule for type of project under review. Good for only one review cycle.
Application submission After 30 days has lapsed and no later than six months after the department's receipt of Letter of Intent. After 30 days has lapsed and no later than six months after the department's receipt of Letter of Intent. Submitted in conformance with published schedule for type of project under review.
Application screening Within 15 working days after application submission. Within 15 working days after application submission. Within 30 days after application submission.

Applicant response

(Applicant may request the screening and response activity be conducted a second time.)

Within 45 days of receiving department's request for additional information.

(Additional responses to screening letters will be accepted up to 10 days after the notice of Beginning of Review.)

Within 45 days of receiving department's request for additional information.

(Additional responses to screening letters will be accepted up to 10 days after the notice of Beginning of Review.)

 Within 30 days of receiving department's request for additional information.
Formal review period

(Formal review begins on fifth working day after applicant's request to begin review, or the department declares the application complete.)

 A total of 90 days

First 35 days open to general public comment and conducting a public hearing if requested.

Last 10 days open for applicant/ interested persons rebuttal statements submitted during first 35 days of public comment period

Last 45 days ex parte period. Department is preparing written analysis and decision.

 A total of 50 days

First 20 days open to general public comment.

Last 10 days open for applicant/ interested persons rebuttal statements submitted during first 20 days of public comment period.

No public hearing conducted on projects qualifying for expedited review.

Last 20 days ex parte period. Department is preparing written analysis and decision.

 A total of 135 days

First 60 days open to general public comment and conducting a public hearing if requested.

Last 30 days open for applicant/ interested persons rebuttal statements submitted during first 60 days of public comment period

Last 45 days ex parte period. Department is preparing written analysis and decision.

Application Resources

Consultant Resource List for Certificate of Need Applications

Certificate of Need (CN) applications require a degree of detail to be complete. To support applicants, the Department of Health provides the following List of Consultants (PDF) as a helpful resource.

Note: This list is provided as a convenience and is not exhaustive of all consultants available in the area. Inclusion on the list does not imply endorsement by the Department of Health or the CN Program. Neither the Department of Health nor the CN program will be involved in any disputes or concerns related to a consultant’s performance.

Contact and connect

  • Visit our Contact Info & Partner Programs page for Certificate of Need Program contact and mailing information.
  • To receive updates from the Certificate of Need Program, subscribe at the bottom of this page.