Current through Register Vol. 24-18, September 15, 2024
(1)
Provisions for exemptions.
The secretary's designee shall grant an exemption from the
requirements for a certificate of need for the offering of an inpatient
institutional health service, the acquisition of major medical equipment for
the provision of an institutional health service, or the obligation of a
capital expenditure in excess of the expenditure minimum for the provision of
an inpatient institutional health service to any entity meeting the eligibility
requirements set forth in subsection (1)(a) of this section for such an
exemption and submitting an application for an exemption meeting the
requirements of subsection (1)(b) of this section.
(a) Eligibility requirements.
To be eligible for an exemption from the requirements for a
certificate of need for the offering of an inpatient institutional health
service, the acquisition of major medical equipment for the provision of an
inpatient institutional health service, or the obligation of a capital
expenditure in excess of the expenditure minimum for the provision of an
institutional health service, an applicant entity shall be one of the
following:
(i) A health maintenance
organization or a combination of health maintenance organizations if:
(A) 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;
(B) The
facility in which the service will be provided is or will be geographically
located so the service will be reasonably accessible to such enrolled
individuals; and
(C) At least
seventy-five percent of the patients reasonably expected to receive the
institutional health service will be individuals enrolled in such organization
or organizations in the combination;
(ii) A health care facility if:
(A) The facility primarily provides or will
provide inpatient health services;
(B) 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;
(C) The facility is or will be geographically
located so the service will be reasonably accessible to such enrolled
individuals; and
(D) At least
seventy-five percent of the patients reasonably expected to receive the
institutional health service will be individuals enrolled with such
organization or organizations in the combination; or
(iii) A health care facility (or portion
thereof) if:
(A) 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 for an
exemption is submitted, at least fifteen years remain in the term of the
lease;
(B) The facility is or will
be geographically located so the service will be reasonably accessible to such
enrolled individuals; and
(C) At
least seventy-five percent of the patients reasonably expected to receive the
institutional health service will be individuals enrolled with such
organization;
(b) Requirements for an application for
exemption.
An application for an exemption from a certificate of need
shall meet the following requirements:
(i) The application for an exemption shall
have been submitted at least thirty days prior to the offering of the
institutional health service, acquisition of major medical equipment, or
obligation of the capital expenditure to which the application pertains. A copy
of the application for the exemption shall be sent simultaneously to the
appropriate advisory review agencies.
(ii) A complete application shall be
submitted in such form and manner as has been prescribed by the department. The
information which the department prescribes shall include:
(A) All of the information required to make a
determination that the applicant entity qualifies in accordance with subsection
(1)(a) of this section; and
(B) A
complete description of the offering, acquisition, or obligation to which the
application pertains.
(2) Action on an application for exemption.
(a) Within thirty days after receipt of a
complete application for exemption from certificate of need requirements, the
department shall send the applicant a written notice the exemption has been
granted or denied. A copy of such written notice shall be sent simultaneously
to the appropriate advisory review agencies.
(b) The secretary's designee shall deny an
exemption if he or she finds the applicant has not met the requirements of
subsections (1)(a) and (b) of this section. Written notice of the denial shall
include the specific reasons for the denial.
(c) In the case of an application for a
proposed health care facility (or portion thereof) which has not begun to
provide institutional health services on the date the application for an
exemption is submitted, the secretary's designee shall grant the exemption if
he or she determines the facility (or portion thereof) will meet the applicable
requirements of subsection (1)(a) of this section when the facility first
provides health services.
(d) If
the secretary's designee fails to grant or deny an exemption in accordance with
the provisions of this section within thirty days after receipt of a complete
application for such exemption, the applicant for the exemption may seek a writ
of mandamus from superior court pursuant to chapter 7.16 RCW.
(3) Subsequent sale, lease, or
acquisition of exempt facilities or equipment.
Subsequent sale, lease, or acquisition of exempt health care
facilities (or portions thereof) or medical equipment for which an exemption
was granted under the provisions of subsection (2) of this section, any
acquisition of a controlling interest in such facility or equipment, and any
use of such facility or equipment by a person other than the one to whom the
exemption was granted, shall meet one of the following conditions:
(a) A certificate of need for the purchase,
lease, acquisition of controlling interest in, or use of such facility or
equipment, shall have been applied for and issued by the department;
or
(b) The department shall have
determined, after receipt of an application for an exemption, submitted in
accordance with subsection (1) of this section, that the requirements of either
subsection (1)(a)(i) or subsection (1)(a)(ii)(A) and (B) are met.
(4) The method of payment for
services (i.e., prepaid or fee for service) shall not be considered relevant in
determining whether an undertaking of a health maintenance organization
qualifies for an exemption under this section.
Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121),
recodified as § 246-310-040, filed 12/27/90, effective 1/31/91. Statutory
Authority:
RCW
70.38.135. 86-06-030 (Order 2344), §
248-19-405, filed 2/28/86; 81-09-012 (Order 210), § 248-19-405, filed
4/9/81, effective 5/20/81.
