Last updated: November 2026. Statute and rule pages opened 2026-11-05.
Washington requires a certificate of need or a granted exception before a covered undertaking starts (RCW 70.38.105(3)). A certificate of need application is the filing a provider makes to the Washington State Department of Health. Integral Healthcare Solutions (IHS) drafts the application narrative, need and utilization worksheets and review calendar for providers adding beds, a hospice, dialysis stations or an ambulatory surgical facility. The applicant files and attends.
IHS supports planning, finance and legal leaders; counsel assesses reviewability.
What does Washington require for a certificate of need?
Under RCW 70.38.105(3), no person may engage in an undertaking that is subject to review without first receiving from the Department of Health either a certificate of need or an exception granted under the chapter. The governing text is chapter 70.38 RCW, "Health Planning and Development": RCW 70.38.025, RCW 70.38.105, RCW 70.38.111, RCW 70.38.115 and RCW 70.38.125, plus the fee rule WAC 246-310-990. The pages carry no "current through" date; the fee rule's history shows an amendment effective 10/10/26, and the latest amendments listed for RCW 70.38.025, .105, .115 and .125 are 2024, 2012, 1996 and 1989.
The points that shape an application:
- No splitting. A person may not divide a project to avoid the review thresholds (70.38.105(6)).
- Review criteria. RCW 70.38.115(2) includes need, alternatives, financial feasibility and community cost impacts, plus project-specific criteria, subject to subsection (3) for HMOs and HMO-controlled facilities.
- Information. Within 15 days of receiving an application, the department requests necessary information or starts review. An applicant may decline by written notice; review then starts when the department receives that notice. Missing required and necessary information can result in denial or limitation (70.38.115(6)).
- Validity. A certificate is valid for two years and the project must commence in that period. One six-month extension may be made if it can be substantiated that substantial and continuing progress toward commencement has been made, as defined by regulations. The department monitors approved projects and may require progress reports (70.38.125(1) to (3)).
| Type of review | Limit | Section |
|---|---|---|
| Outside concurrent review | 90 days; extendable up to 30 days if a review agency needs it, up to 30 more for unresolved pivotal issues, and in any case if the applicant agrees | 70.38.115(8) |
| Concurrent review | 150 days, except as the department's rules on amendment during review provide, or for an unresolved pivotal issue the department declares | 70.38.115(7) |
Concurrent review compares competing or similar projects; its categories include at least new health care facilities, new services and expansion of existing facilities (70.38.115(7)). The department holds a public hearing on request unless the review is expedited or an emergency review (70.38.115(9)). Confirm the track with counsel before you set the calendar.
Who needs a Washington certificate of need, and what triggers it?
A person needs a certificate, or an exception, when the project falls in a category listed in RCW 70.38.105(4). The first category is establishing a "health care facility," which RCW 70.38.025(6) defines to mean hospices, hospice care centers, hospitals, behavioral health hospitals, nursing homes, kidney disease treatment centers, ambulatory surgical facilities and home health agencies, with exclusions for certain religious and convent facilities and certain nonprofit children's hospitals. A new hospice or ambulatory surgical facility is therefore in the same category as a new hospital. Exemptions apply on stated conditions (RCW 70.38.111), and the fee rule lists a "determination of reviewability." Counsel advises on applicability. Examples of review categories follow; consult the full list in RCW 70.38.105(4).
- New health care facilities and hospital transactions (70.38.105(4)(a) and (b)); the hospital exceptions in (7)(a) and (b) concern HMOs operating group practices continuously licensed as HMOs since January 1, 2009.
- Nursing home construction, renovation or alteration expenditures that substantially change services after January 1, 1981, as specified by department rule, or exceed the expenditure minimum defined in RCW 70.38.025(5); (4)(d) contains conditional exclusions (70.38.105(4)(c) and (d)).
- Increased licensed beds or redistribution among acute, nursing home and assisted living care lasting more than six months; rural facilities and critical access hospitals have separate provisions (70.38.105(4)(e)).
- New tertiary services offered in or through a health care facility or a rural health care facility licensed under RCW 70.175.100, not regularly offered by, in or through that facility during the preceding twelve months (70.38.105(4)(f)).
- Increased dialysis stations in a kidney disease center (70.38.105(4)(h)).
How does IHS prepare a Washington certificate of need application?
IHS works as an outside drafting team under your leaders and counsel, in five steps.
- Gap assessment. IHS compares your plan to the applicable RCW 70.38.115 criteria and lists missing evidence.
- Evidence mapping. IHS maps each criterion to the data that answers it.
- Drafting. IHS drafts the narrative organized to the criteria, worksheets, an alternatives outline, the review timeline and an attachment checklist, for your leaders and counsel to approve.
- Mock review. IHS reads the draft as a reviewer would: does each criterion have a number, a source and an owner?
- Readiness support. IHS drafts a post-approval calendar for the validity period, progress reports and the modifications that need an amended certificate (70.38.115(11)).
What you supply: the project description, capital expenditure estimate, location and service line; utilization and population data; financial statements and projections; an applicant signatory; and counsel for legal questions, including reviewability.
The real limit: the applicant files with the Department of Health, pays the fee and attends any hearing. IHS does not file, attend or communicate with the department for you, gives no legal advice on reviewability, denial or appeal, and does not guarantee issuance.
IHS was founded in 2002 and is led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC. IHS works across three practice lines: accreditation consulting, compliance services and program development. This program sits in compliance services.
What should an applicant have ready for a Washington certificate of need?
Prepare these for the gap assessment. Citations refer to the RCW text opened November 5, 2026, and the fee rule effective October 10, 2026.
- Counsel's view on whether the project is subject to review or fits an exception, or a decision to request a determination of reviewability (RCW 70.38.105(4); RCW 70.38.111).
- One project description showing no division to avoid thresholds (RCW 70.38.105(6)).
- Capital expenditure estimates and the applicable fee category, including rural designation where relevant (WAC 246-310-990).
- Population and utilization data showing the need for the service (RCW 70.38.115(2)(a)).
- An analysis of less costly or more effective alternatives (RCW 70.38.115(2)(b)).
- Financial statements and projections showing feasibility and the probable effect on costs and charges (RCW 70.38.115(2)(c)).
- Evidence for any further criteria that fit the project type (RCW 70.38.115(2)(d) to (k)).
- The department-required application information and a plan for responding to additional requests (RCW 70.38.115(6)).
- A calendar for the 90-day or 150-day period, extensions and any hearing (RCW 70.38.115(7) to (9)).
- A tracker for the validity period, the extension and progress reports (RCW 70.38.125(1) to (3)).
If most of these do not exist yet, a free introductory call with IHS sorts what to build first.
How does an outside application build compare with the other routes?
An applicant can combine these routes. The table lists them without ranking them.
| Route | What it involves | Where the work sits |
|---|---|---|
| Internal build | Planning and finance staff write the narrative and worksheets. | Your staff time. |
| Counsel | Advises on reviewability, exceptions, hearings and appeals. | Legal determinations, which IHS does not give. |
| Department requirements | Chapter 246-310 WAC and the information the department specifies (70.38.115(6)). | The applicant reads and follows them. |
| Outside drafting support (IHS) | IHS drafts the narrative, worksheets and calendar. | IHS drafts; the applicant files and attends. |
What does a Washington certificate of need application cost?
Your organization carries internal staff time, and the Department of Health charges its own fees. IHS scopes each engagement after a free introductory call.
The department publishes its fees in WAC 246-310-990 (opened 2026-11-05). Application fees apply per facility or project type in Table 1. The designated-rural-area fee replaces the percentage calculation. Verify current fees with the Washington Department of Health.
| Fee | Amount |
|---|---|
| Application fee per facility or project type | 1.15 percent of total estimated project capital expenditure; minimum USD 25,000, maximum USD 80,000 |
| Designated-rural-area application fee, per facility or project application | USD 25,000 |
| Determination of reviewability | USD 12,500 |
| Emergency review | USD 9,500 |
| Ambulatory surgical center exemption request, nonrefundable | USD 18,000 |
| Extension of the validity period, nonrefundable | USD 1,000 |
What this is not
This is not legal advice. IHS is a consulting firm, not a law firm. Reviewability, exceptions, denials and appeals are questions for your counsel.
It is not a filing service. The applicant files and attends any hearing.
It is not a guarantee that a certificate will be issued, and IHS does not communicate with the department for you.
Frequently asked questions
What is a certificate of need in Washington and which projects need one?
It is the Department of Health's approval, under chapter 70.38 RCW, that a person must receive before starting an undertaking subject to review, unless the department has granted an exception (RCW 70.38.105(3)). The categories are listed in RCW 70.38.105(4), each with its own conditions.
Does my hospice, dialysis or ambulatory surgery project need a certificate of need in Washington?
Added dialysis stations in a kidney disease center are listed in RCW 70.38.105(4)(h). RCW 70.38.025(6) includes hospices, hospice care centers and ambulatory surgical facilities in "health care facility," so establishing one falls under RCW 70.38.105(4)(a). Exemptions and your project's facts decide the outcome; counsel makes that call.
What criteria does Washington use to review a certificate of need application?
RCW 70.38.115(2) includes need, alternatives, financial feasibility and project-specific criteria. Subsection (3) provides separate treatment for HMOs and HMO-controlled facilities. IHS organizes the narrative to the applicable criteria.
How long does a Washington certificate of need review take?
Nonconcurrent review is limited to 90 days, extendable by up to 30 days for a review agency, another 30 for unresolved pivotal issues, or by applicant agreement (RCW 70.38.115(8)). Concurrent review starts 15 days after the submission window closes and is limited to 150 days, except under department rules permitting amendments during review or for a department-declared unresolved pivotal issue (RCW 70.38.115(7)).
What is the Washington certificate of need application fee?
For each facility or project type, the application fee is 1.15 percent of estimated project capital expenditure, with a minimum of USD 25,000 and a maximum of USD 80,000. For a facility or project in a designated rural area, the fee is USD 25,000 per facility or project application (WAC 246-310-990). Verify current fees with the Washington Department of Health.
What is the penalty for building or offering a service without a certificate of need in Washington?
A person who undertakes a reviewable project without a certificate or an exception is liable to the state for up to USD 100 for each day of the unauthorized offering or development, recoverable in an attorney general action (RCW 70.38.125(5)). No license issues for a new health facility until a certificate has been issued for it (RCW 70.38.125(4)).
How long is a Washington certificate of need valid?
Two years. One six-month extension may be made if it can be substantiated that substantial and continuing progress toward commencement has been made, as defined by regulations (RCW 70.38.125(1)).
What if the department denies the application?
An applicant denied a certificate, or whose certificate is suspended or revoked, has the right to an adjudicative proceeding under chapter 34.05 RCW (RCW 70.38.115(10)(a)). Your counsel advises on that step.
Related pages
See the Compliance Services overview | State licensing and certificate of need.