(1) The
department shall not require a certificate of need for the
offering of an inpatient tertiary health service by:
(a) A health maintenance organization or a combination of
health maintenance organizations if (i) the organization or
combination of organizations has, in the service area of the
organization or the service areas of the organizations in the
combination, an enrollment of at least fifty thousand
individuals, (ii) the facility in which the service will be
provided is or will be geographically located so that the service
will be reasonably accessible to such enrolled individuals, and
(iii) at least seventy-five percent of the patients who can
reasonably be expected to receive the tertiary health service
will be individuals enrolled with such organization or
organizations in the combination;
(b) A health care facility if (i) the facility primarily
provides or will provide inpatient health services, (ii) the
facility is or will be controlled, directly or indirectly, by a
health maintenance organization or a combination of health
maintenance organizations which has, in the service area of the
organization or service areas of the organizations in the
combination, an enrollment of at least fifty thousand
individuals, (iii) the facility is or will be geographically
located so that the service will be reasonably accessible to such
enrolled individuals, and (iv) at least seventy-five percent of
the patients who can reasonably be expected to receive the
tertiary health service will be individuals enrolled with such
organization or organizations in the combination; or
(c) A health care facility (or portion thereof) if (i) the
facility is or will be leased by a health maintenance
organization or combination of health maintenance organizations
which has, in the service area of the organization or the service
areas of the organizations in the combination, an enrollment of
at least fifty thousand individuals and, on the date the
application is submitted under subsection (2) of this section, at
least fifteen years remain in the term of the lease, (ii) the
facility is or will be geographically located so that the service
will be reasonably accessible to such enrolled individuals, and
(iii) at least seventy-five percent of the patients who can
reasonably be expected to receive the tertiary health service
will be individuals enrolled with such organization;
if, with respect to such offering or obligation by a nursing
home, the department has, upon application under subsection (2)
of this section, granted an exemption from such requirement to
the organization, combination of organizations, or facility.
(2) A health maintenance organization, combination of health
maintenance organizations, or health care facility shall not be
exempt under subsection (1) of this section from obtaining a
certificate of need before offering a tertiary health service
unless:
(a) It has submitted at least thirty days prior to the
offering of services reviewable under RCW 70.38.105(4)(d) an
application for such exemption; and
(b) The application contains such information respecting the
organization, combination, or facility and the proposed offering
or obligation by a nursing home as the department may require to
determine if the organization or combination meets the
requirements of subsection (1) of this section or the facility
meets or will meet such requirements; and
(c) The department approves such application. The
department shall approve or disapprove an application for
exemption within thirty days of receipt of a completed
application. In the case of a proposed health care facility (or
portion thereof) which has not begun to provide tertiary health
services on the date an application is submitted under this
subsection with respect to such facility (or portion), the
facility (or portion) shall meet the applicable requirements of
subsection (1) of this section when the facility first provides
such services. The department shall approve an application
submitted under this subsection if it determines that the
applicable requirements of subsection (1) of this section are
met.
(3) A health care facility (or any part thereof) with
respect to which an exemption was granted under subsection (1) of
this section may not be sold or leased and a controlling interest
in such facility or in a lease of such facility may not be
acquired and a health care facility described in (1)(c) which was
granted an exemption under subsection (1) of this section may not
be used by any person other than the lessee described in (1)(c)
unless:
(a) The department issues a certificate of need approving
the sale, lease, acquisition, or use; or
(b) The department determines, upon application, that (i)
the entity to which the facility is proposed to be sold or
leased, which intends to acquire the controlling interest, or
which intends to use the facility is a health maintenance
organization or a combination of health maintenance organizations
which meets the requirements of (1)(a)(i), and (ii) with respect
to such facility, meets the requirements of (1)(a)(ii) or (iii)
or the requirements of (1)(b)(i) and (ii).
(4) In the case of a health maintenance organization, an
ambulatory care facility, or a health care facility, which
ambulatory or health care facility is controlled, directly or
indirectly, by a health maintenance organization or a combination
of health maintenance organizations, the department may under the
program apply its certificate of need requirements only to the
offering of inpatient tertiary health services and then only to
the extent that such offering is not exempt under the provisions
of this section.
(5)(a) The department shall not require a certificate of
need for the construction, development, or other establishment of
a nursing home, or the addition of beds to an existing nursing
home, that is owned and operated by a continuing care retirement
community that:
(i) Offers services only to contractual members;
(ii) Provides its members a contractually guaranteed range
of services from independent living through skilled nursing,
including some assistance with daily living activities;
(iii) Contractually assumes responsibility for the cost of
services exceeding the member's financial responsibility under
the contract, so that no third party, with the exception of
insurance purchased by the retirement community or its members,
but including the medicaid program, is liable for costs of care
even if the member depletes his or her personal resources;
(iv) Has offered continuing care contracts and operated a
nursing home continuously since January 1, 1988, or has obtained
a certificate of need to establish a nursing home;
(v) Maintains a binding agreement with the state assuring
that financial liability for services to members, including
nursing home services, will not fall upon the state;
(vi) Does not operate, and has not undertaken a project that
would result in a number of nursing home beds in excess of one
for every four living units operated by the continuing care
retirement community, exclusive of nursing home beds; and
(vii) Has obtained a professional review of pricing and
long-term solvency within the prior five years which was fully
disclosed to members.
(b) A continuing care retirement community shall not be
exempt under this subsection from obtaining a certificate of need
unless:
(i) It has submitted an application for exemption at least
thirty days prior to commencing construction of, is submitting an
application for the licensure of, or is commencing operation of a
nursing home, whichever comes first; and
(ii) The application documents to the department that the
continuing care retirement community qualifies for exemption.
(c) The sale, lease, acquisition, or use of part or all of a
continuing care retirement community nursing home that qualifies
for exemption under this subsection shall require prior
certificate of need approval to qualify for licensure as a
nursing home unless the department determines such sale, lease,
acquisition, or use is by a continuing care retirement community
that meets the conditions of (a) of this subsection.
(6) A rural hospital, as defined by the department, reducing
the number of licensed beds to become a rural primary care
hospital under the provisions of Part A Title XVIII of the Social
Security Act Section 1820, 42 U.S.C., 1395c et seq. may, within
three years of the reduction of beds licensed under chapter 70.41 RCW, increase the number of licensed beds to no more than the
previously licensed number without being subject to the
provisions of this chapter.
(7) A rural health care facility licensed under RCW 70.175.100 formerly licensed as a hospital under chapter 70.41 RCW may, within three years of the effective date of the rural
health care facility license, apply to the department for a
hospital license and not be subject to the requirements of RCW 70.38.105(4)(a) as the construction, development, or other
establishment of a new hospital, provided there is no increase in
the number of beds previously licensed under chapter 70.41 RCW
and there is no redistribution in the number of beds used for
acute care or long-term care, the rural health care facility has
been in continuous operation, and the rural health care facility
has not been purchased or leased.
(8)(a) A nursing home that voluntarily reduces the number of
its licensed beds to provide assisted living, licensed boarding
home care, adult day care, adult day health, respite care,
hospice, outpatient therapy services, congregate meals, home
health, or senior wellness clinic, or to reduce to one or two the
number of beds per room or to otherwise enhance the quality of
life for residents in the nursing home, may convert the original
facility or portion of the facility back, and thereby increase
the number of nursing home beds to no more than the previously
licensed number of nursing home beds without obtaining a
certificate of need under this chapter, provided the facility has
been in continuous operation and has not been purchased or
leased. Any conversion to the original licensed bed capacity, or
to any portion thereof, shall comply with the same life and
safety code requirements as existed at the time the nursing home
voluntarily reduced its licensed beds; unless waivers from such
requirements were issued, in which case the converted beds shall
reflect the conditions or standards that then existed pursuant to
the approved waivers.
(b) To convert beds back to nursing home beds under this
subsection, the nursing home must:
(i) Give notice of its intent to preserve conversion options
to the department of health no later than thirty days after the
effective date of the license reduction; and
(ii) Give notice to the department of health and to the
department of social and health services of the intent to convert
beds back. If construction is required for the conversion of
beds back, the notice of intent to convert beds back must be
given, at a minimum, one year prior to the effective date of
license modification reflecting the restored beds; otherwise, the
notice must be given a minimum of ninety days prior to the
effective date of license modification reflecting the restored
beds. Prior to any license modification to convert beds back to
nursing home beds under this section, the licensee must
demonstrate that the nursing home meets the certificate of need
exemption requirements of this section.
The term "construction," as used in (b)(ii) of this
subsection, is limited to those projects that are expected to
equal or exceed the expenditure minimum amount, as determined
under this chapter.
(c) Conversion of beds back under this subsection must be
completed no later than four years after the effective date of
the license reduction. However, for good cause shown, the
four-year period for conversion may be extended by the department
of health for one additional four-year period.
(d) Nursing home beds that have been voluntarily reduced
under this section shall be counted as available nursing home
beds for the purpose of evaluating need under RCW 70.38.115(2)
(a) and (k) so long as the facility retains the ability to
convert them back to nursing home use under the terms of this
section.
(e) When a building owner has secured an interest in the
nursing home beds, which are intended to be voluntarily reduced
by the licensee under (a) of this subsection, the applicant shall
provide the department with a written statement indicating the
building owner's approval of the bed reduction.
[1997 c 210 § 1; 1995 1st sp.s. c 18 § 71; 1993 c 508 § 5; 1992 c 27 § 2; 1991 c 158 § 2; 1989 1st ex.s. c 9 § 604; 1982 c 119 § 3; 1980 c 139 § 9.]
NOTES:
Conflict with federal requirements -- Severability -- Effective date -- 1995 1st sp.s. c 18: See notes following RCW 74.39A.030.
Section captions--Severability -- Effective date--1993 c 508: See RCW 74.39A.900 through 74.39A.903.