HB 1979
In CommitteeHouse
Cardiac care cert. of need
Updating cardiac care certificate of need requirements.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill updates Washington’s Certificate of Need (CON) rules to improve access, safety, and stability in cardiac care — especially for elective PCI at hospitals without on-site cardiac surgery — while expanding CON exemptions for rural, behavioral health, and culturally specific services. It also clarifies exemptions for HMOs and continuing care retirement communities.
- Requires the Washington Department of Health to adopt new rules for issuing Certificates of Need for elective percutaneous coronary interventions (PCI) at hospitals that do not offer on-site cardiac surgery — based on an independent evidence review covering access, safety, quality, cost, and system stability.
- Maintains and clarifies CON exemptions for HMOs and affiliated facilities offering inpatient tertiary services to at least 50,000 enrolled members, with geographic and access requirements.
- Adds or extends CON exemptions for specific providers: rural hospitals, continuing care retirement communities, culturally specific hospice agencies, behavioral health units (up to 16 beds), and hospital-at-home programs.
- Allows certain nursing homes to convert previously reduced beds back to nursing home use — up to the original licensed number — without a CON, if done within 4 years (extendable once) and under specific conditions.
- Suspends CON requirements for hospitals increasing psychiatric beds (including for involuntary commitments) between May 5, 2017, and June 30, 2028, with exemptions valid for 2 years at a time.
Who is affected
- Hospitals performing elective PCI without on-site cardiac surgery — Hospitals that perform elective percutaneous coronary interventions (PCI) but do not offer on-site cardiac surgery — this bill changes the rules under which they must obtain a Certificate of Need (CON) to offer these services, and may require them to meet new evidence-based criteria.
- Health maintenance organizations (HMOs) and affiliated facilities — Health maintenance organizations (HMOs) and facilities they control or lease — this bill updates and clarifies CON exemptions for offering inpatient tertiary services to their enrolled members, especially when serving at least 50,000 enrollees.
- Continuing care retirement communities (CCRCs) — Continuing care retirement communities (CCRCs) with nursing homes — this bill modifies CON requirements for building, expanding, or transferring such facilities, provided they meet specific financial and service guarantees.
- Rural hospitals and rural health facilities — Rural hospitals and rural health facilities — this bill adds or extends CON exemptions for bed reductions, conversions, or license renewals under specific rural health programs.
- Nursing homes, hospice agencies, and behavioral health providers — Nursing homes, hospice agencies, and behavioral health providers — this bill expands CON exemptions for specific types of services, including bed reductions for quality-of-life improvements, culturally specific hospice, and short-stay psychiatric or behavioral health units.
Pro/Con Analysis
Potential Benefits (5)
Creates a targeted exemption for culturally specific hospice agencies serving religious or ethnic minority groups, improving access to end-of-life care aligned with cultural and religious values — a need historically unmet by mainstream providers and critical for equity in rural or underserved communities.
HealthcarePeopleRef: Sec. 2, RCW 70.38.111(10)(a)-(vii)Expands CON exemptions for rural hospitals converting to rural primary care or renewing licenses after losing critical access status, helping preserve essential local inpatient services in geographically isolated areas where travel distances would otherwise delay emergency or chronic care.
HealthcarePeopleRef: Sec. 2, RCW 70.38.111(6), (7), (8)Exempts behavioral health units of up to 16 beds for adults on involuntary commitments, directly increasing capacity for crisis stabilization — a critical gap in Washington’s mental health system — especially in counties lacking dedicated psychiatric facilities.
HealthcarePeopleRef: Sec. 2, RCW 70.38.111(11)(b)(ii)Exempts hospital-at-home programs from CON, supporting innovation in home-based acute care — which can improve patient convenience, reduce exposure to hospital-acquired infections, and lower costs for Medicare/Medicaid beneficiaries with mobility or transportation barriers.
HealthcarePeopleRef: Sec. 2, RCW 70.38.111(14)Requires rules for elective PCI to consider national safety/quality standards and community access — potentially enabling more equitable distribution of cardiac services outside King County, reducing travel burdens for patients in rural or suburban areas.
HealthcarePeopleRef: Sec. 1, RCW 70.38.128(2)
Potential Concerns (5)
Mandates evidence-based rulemaking for elective PCI at hospitals without on-site cardiac surgery, but the requirement to maintain University of Washington academic center volumes may prioritize institutional training needs over broader system stability, potentially limiting access expansion in other regions.
Public SafetyRef: Sec. 1, RCW 70.38.128(1)Expands HMO exemption for offering inpatient tertiary services to 50,000+ enrollees, which disproportionately benefits large, multi-regional HMOs (e.g., Kaiser Permanente, UnitedHealthcare) over smaller insurers or community health plans that cannot meet the enrollment threshold.
Business & EmploymentRef: Sec. 2, RCW 70.38.111(1)(a)-(c)Exempts large, financially stable Continuing Care Retirement Communities (CCRCs) from CON requirements, but the stringent financial and solvency requirements (e.g., binding state-assured liability, 5-year pricing review) exclude smaller or newer providers, effectively protecting incumbent CCRCs with high upfront costs and long-term contracts.
HousingRef: Sec. 2, RCW 70.38.111(5)(a)-(vii)Allows nursing homes to convert reduced beds back without CON, but the 4-year (extendable) deadline and notice requirements create a narrow window that favors large, well-resourced chains with legal and administrative capacity, while smaller operators may miss deadlines or lack resources to comply.
Business & EmploymentRef: Sec. 2, RCW 70.38.111(9)(a)-(e)Suspends CON for psychiatric bed increases from 2017–2028, but the 2-year exemption renewal cycle creates regulatory uncertainty and may incentivize short-term capacity expansion over long-term system planning, potentially undermining sustainability of behavioral health infrastructure.
Public SafetyRef: Sec. 2, RCW 70.38.111(11)(a)
Who Is Most Affected
Large HMOs with 50,000+ enrollees gain regulatory relief to expand inpatient tertiary services without CON review, reinforcing their market position; smaller insurers and community health plans are excluded due to the high enrollment threshold.
Rural hospitals and critical access facilities gain flexibility to adjust bed capacity without CON, helping them remain viable in areas where population decline or workforce shortages threaten closure — though only if they meet strict statutory conditions.
Culturally specific hospice agencies gain a new exemption allowing them to operate without CON, directly addressing long-standing gaps in culturally congruent end-of-life care for minority populations.
Nursing homes benefit from relaxed CON for bed conversions, but only if they can meet tight deadlines and documentation requirements — favoring large chains with administrative capacity over small, independent operators.
Patients in rural or underserved areas may benefit from expanded access to behavioral health and cardiac services, but those in non-rural areas may see little change; the HMO exemption may reduce competition from independent providers.