SB 5448
In CommitteeSenate
Dialysis/certificate of need
Exempting certain dialysis services from 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 removes the certificate of need requirement for dialysis services provided on-site to residents of skilled nursing facilities, treating those services as home hemodialysis under federal rules and allowing them to be offered without additional state regulatory approval.
- Exempts dialysis services provided on-site to residents of a skilled nursing facility from the state’s certificate of need (CON) requirement.
- Clarifies that such dialysis services are treated as 'home hemodialysis' under federal Medicare/Medicaid rules, which have different regulatory standards.
- Requires the Washington Department of Health to accept this federal classification and not impose CON review for these services.
- Applies only to dialysis provided directly to skilled nursing facility residents within the facility — not to standalone dialysis centers or off-site dialysis services.
Who is affected
- Skilled nursing facilities — Skilled nursing facilities that provide dialysis to their residents will no longer need to obtain a certificate of need for offering on-site dialysis services to those residents.
- Dialysis service providers — Dialysis providers who currently operate separately from skilled nursing facilities may benefit from simplified access to provide dialysis in those facilities if they meet other exemption criteria (e.g., through affiliation with large health maintenance organizations).
- Patients in skilled nursing facilities — Patients in skilled nursing facilities who need dialysis will have improved access to on-site dialysis without delays caused by certificate of need approval processes.
- Washington State Department of Health — The Washington State Department of Health will no longer process certificate of need applications for on-site dialysis in skilled nursing facilities, reducing administrative burden.
Pro/Con Analysis
Potential Benefits (2)
Patients in skilled nursing facilities — especially those with mobility limitations, cognitive impairment, or transportation barriers — will gain timely access to dialysis without delays from state CON review, reducing hospitalizations and improving continuity of care for a high-need, low-mobility population.
HealthcarePeopleRef: Sec. 1, subsection (15)Skilled nursing facilities (SNFs) can now offer dialysis as a value-added service without costly and time-consuming state approval, potentially increasing their revenue and ability to retain staff — though this may be limited to larger SNF chains with the infrastructure to support dialysis, not small independent facilities.
Business & EmploymentPeopleRef: Sec. 1, subsection (15)
Potential Concerns (3)
Exempting on-site dialysis in skilled nursing facilities from certificate of need (CON) review removes a layer of state oversight that previously ensured clinical appropriateness, staffing adequacy, and infection control protocols for dialysis services — increasing risk of substandard care if facilities lack nephrology oversight or fail to meet CMS home-dialysis standards.
Public SafetyPeopleRef: Sec. 1, subsection (15)While intended to expand access, the bill may disproportionately benefit large health maintenance organizations (HMOs) with 50,000+ enrollments (per subsections (1)(a)-(c)), which are better positioned to meet the eligibility thresholds for CON exemptions — effectively consolidating dialysis provision under large health systems rather than expanding access for smaller providers or rural communities.
HealthcarePeopleRef: Sec. 1, subsection (15)The bill shifts regulatory responsibility for dialysis quality from state oversight (via CON) to federal CMS standards alone, reducing the state’s ability to enforce Washington-specific patient safety or equity requirements — potentially weakening accountability for outcomes in vulnerable long-term care settings.
Local GovernmentPeopleRef: Sec. 1, subsection (15)
Who Is Most Affected
Residents of skilled nursing facilities — especially frail, elderly, or disabled individuals — are the primary intended beneficiaries. They gain faster, more convenient dialysis access, reducing hospital transfers and improving quality of life. However, those in under-resourced facilities may still face quality gaps if oversight is reduced.
Large HMOs with 50,000+ enrollments (per subsections (1)(a)-(c)) gain a new pathway to offer integrated dialysis services without state approval, strengthening their vertical integration and market power. Smaller providers or standalone dialysis centers are excluded from this exemption and may lose patients.
Skilled nursing facilities with existing dialysis infrastructure or partnerships with HMOs may expand services and revenue, but small or rural SNFs lacking capital or HMO affiliation may not qualify for the exemption and remain unable to offer dialysis.
Dialysis providers affiliated with qualifying HMOs gain streamlined access to SNF markets, but independent dialysis companies lose potential revenue from SNF contracts and face increased competition from vertically integrated HMOs.
The Department of Health avoids processing CON applications for this service, reducing administrative burden — but also loses regulatory leverage to ensure quality and equity in dialysis delivery within long-term care settings.