Certificate of Need Rulemaking, Rules, and Statutes

Last revised date: January 7, 2026

Revised Code of Washington (RCW) statutes

Certificate of Need (RCW 70.38)

Acquisition of Non-Profit Hospitals (RCW 70.45)

Antitrust Immunity (RCW 43.72)

Washington Administrative Code (WAC) rules

Certificate of Need (WAC 246-310)

Acquisition of Non-Profit Hospitals (WAC 246-312)

Antitrust Immunity (WAC 246-25)

Proviso Report

Proviso Report

Background

The Department of Health was allocated funds to analyze the Certificate of Need program and report findings to the legislature and governor by June 30, 2025. The report will explore other states' strategies, healthcare access, cost management, equity, and methods for identifying service needs. A research firm with expertise in healthcare economics and data analytics has been contracted with to assist with research and recommendations.

Report to the Legislature

The report was made available in July 2025. Read the full report (PDF).

Preliminary Findings Presentations

BerryDunn presented on the preliminary findings for modernizing the CN program on three separate dates. A recording of these presentations is available upon request. 

You may also view the Preliminary Findings Presentation (PDF).

Presentation Date and Time
#1 Wednesday, November 13, 2024, 9 a.m. - 11 a.m.
#2 Tuesday, November 19, 2024, 2 p.m. - 4 p.m. 
#3 Wednesday, November 20, 2024, 10 a.m. - noon

Past Workshops

To access comments related to this work email the Certificate of Need rules team.
Workshop Date and Time
#1 Tuesday, July 30, 2024, 9 a.m. - 11 a.m.
#2 Thursday, August 1, 2024, 4 p.m. - 6 p.m.
#3 Wednesday, August 7, 2024, 9 a.m. - 11 a.m.
#4 Thursday, August 8, 2024, 4 p.m. - 6 p.m.
#5 Thursday, September 19, 2024, 11 a.m. - 1 p.m.
#6 Tuesday, October 1, 2024, 9 a.m. - 1 p.m.
#7 Wednesday, October 8, 2024, 10 a.m. - noon

Current Rules in Progress

In-Home Kidney Dialysis in Nursing Homes

Background

The CN program currently regulates nursing home beds and kidney disease treatment centers as separate facility types in chapter 246-310 WAC. Currently, there are no rules that outline the requirements for the establishment of in-home kidney dialysis services to be provided within nursing home facilities.

The department is considering rules on this subject because of substantial interest from the CN program and among providers and servicers in the dialysis and nursing home communities. Identifying new types of care modalities could increase access to care for nursing home residents in the state of Washington.

The CN rules currently in place create unintentional barriers for patients and for providers and services from delivering an integrated care model with dialysis services provided in nursing homes. These unintentional barriers impact patients access to critical services and can also lead to higher costs through increased transports and staffing requirements.

To expand access to care, the department is considering rules that would establish a clear regulatory framework that outlines requirements to allow in-home dialysis services be performed within a nursing home under the CN program. Having a clear regulatory framework around this modality of care would help increase access to care while also ensuring that the CN program maintains its responsibility to ensure a safe delivery of services to the residents of Washington.

The objective for considering these new rules is to identify and outline clear requirements that would efficiently and effectively regulate these types of services while also working to reduce barriers for both patients and providers.

Considering these rules would work towards creating a clear CN pathway for providers and services who deliver care for this vulnerable population.

The department will also consider amendments to current rules only for the purpose of establishing these new rules.

Rule Activities

Draft Rules

Public Comment

Upcoming Rule Workshops 

Workshop Date & Time Registration Link
#2 Thursday, February 19, 2026; 1:30-3:30 p.m. Register for the February 19 Workshop

Previous Rule Workshop

Workshop Date & Time Workshop Materials
#1 Thursday, November 20, 2025; 1:30-3:30 p.m.

Presentation materials used during the workshop:

Resources shared during the meeting:

 

Review Fees Rule 2025-2026

Background

The Department of Health (department) is considering rule amendments to update Certificate of Need (CN) review fees. Updates to CN fees in WAC 246-310-990 may also consider changes to clarify and standardize language.

The department is considering amendments to sections of rule regarding CN application and review fees to address funding requirements. The fees collected by CN must cover the operational cost of the program including performing reviews; providing technical assistance; conducting public hearings; defending appealed program and department decisions; rule development; and coordinating with state and local authorities. An update may be needed to adequately fund the program. RCW 43.70.250 requires that all program costs be fully borne by the members of the program. Changes to rules are the only way to make fee adjustments.

Rule Activities

WSR 25-17-069 CR-101 (PDF)

Upcoming Rule Workshops 

Additional information will be distributed as it becomes available.

More Agency Rule Resources

Contact and connect

  • Visit our Contact Info and Partner Programs page for Certificate of Need Program contact and mailing information.
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