This bill amends existing certificate of need (CON) law by reenacting and revising RCW 70.38.111 and amending RCW 70.38.128. It requires the Department of Health to adopt rules for when a CON is required for elective percutaneous coronary interventions, directing the department to consider national patient safety and quality standards, community access, and the stability of the state cardiac care system, and to make those rules consistent with an exemption referenced in RCW 70.38.111(15). The prior parenthetical date in RCW 70.38.128 is removed. The bill modifies many CON procedures and exemptions in RCW 70.38.111. It reenacts exemptions for certain inpatient tertiary services offered by HMOs, HMO-controlled facilities, and leased facilities (including a 15-year remaining lease requirement for exemption eligibility), establishes application timing rules (applicants must submit exemption applications at least 30 days before offering services and the department must act within 30 days of a completed application), and places limits on transfers or changes of control of exempted facilities. It adds specific rules for continuing care retirement community nursing home exemptions (including a required professional review within five years) and multiple provisions allowing rural hospitals and rural health care facilities to restore or increase licensed beds or renew hospital licenses without being treated as establishing a new hospital if specified conditions and timeframes are met. The bill also creates or clarifies a range of CON exemptions and procedural changes: nursing homes that voluntarily reduced beds may convert back to prior bed counts under notice, timing, continuous operation, life-and-safety compliance, and completion deadlines (including a four-year conversion window with one possible four-year extension); the department may not require a CON for specified hospice agencies meeting multiple conditions and must count their census in future need calculations; from May 5, 2017, through June 30, 2028 the CON requirement is suspended for hospitals increasing psychiatric beds (exemptions valid for two years); CONs are not required for certain small behavioral health hospitals, specified ambulatory surgical facilities meeting prior operation/approval dates, rural health clinics in certain shortage areas, hospital-at-home services, and elective percutaneous coronary interventions provided at designated accredited or categorized cardiac centers. The changes are procedural and exemption-based; no changes to criminal penalties are identified in the extracted text. Several details are missing from the provided text, including the full text of RCW 70.38.111(15), the remainder of one subsection that was cut off, the specific expenditure minimum that defines “construction,” the full content of cross-referenced RCW and federal provisions, and details of the Washington rural health access preservation pilot. These gaps prevent confirmation of some implementation specifics.

If enacted, the bill would reduce when health care providers need a certificate of need and make it quicker to get exemptions: the Department of Health would adopt rules for elective coronary interventions and must decide exemption applications within 30 days of a completed filing, while many specific services and facility changes (certain heart centers, ambulatory surgical sites with prior operation dates, small culturally specific hospices, hospital-at-home, rural clinics in shortage areas, psychiatric bed increases through mid‑2028, and certain nursing home and rural hospital license restorations) would be allowed without a CON if they meet listed conditions. In practice this likely lowers upfront regulatory costs and delays for hospitals, nursing homes, hospice operators, ambulatory surgery practices, HMOs, and rural providers and gives them clearer short-term options to add or restore beds or services. The Department of Health will take on new rulemaking and faster application processing duties and may need extra staff to meet the 30‑day timelines, while providers gain more flexibility and potentially lower barriers to expand or resume services. There are tradeoffs and some uncertainty: several referenced provisions and dollar thresholds (for what counts as “construction”), a cross-referenced exemption subsection, and the end of one rural-hospital clause are missing from the extracted text, so exact triggers, limits, and long-term oversight details remain unclear and could affect planning and risk for providers and the health system.