The bill amends existing state hospital licensing laws (RCW 70.41.120, 70.41.122, and 70.41.080) to change inspection and fire protection inspection procedures. It requires the department that oversees hospital licensing to conduct unannounced inspections of all hospitals at least every 18 months, but allows hospitals that submit documentary evidence of an equivalent accrediting or CMS certification within 30 days to be inspected at least every 36 months instead. The department cannot issue a final report on an unannounced inspection until the hospital has been given at least two weeks to provide requested information not available during the inspection and until at least one inspector offers to meet personally with the hospital chief administrator or executive officer. The department must coordinate and notify the department of social and health services, the state fire marshal, and relevant local agencies at least four weeks before inspections, invite their attendance, and provide them copies of inspection reports; the department may treat certain accredited or CMS-equivalent surveys as equivalent to its own surveys. The bill also creates procedural changes for fire protection oversight. The chief of the Washington State Patrol, through the director of fire protection, must adopt hospital fire protection standards consistent with CMS standards for facilities serving Medicare or Medicaid patients, use standards for existing buildings when inspecting existing hospitals, and may reinspect when noncompliance constitutes immediate jeopardy or a condition-level violation. The director must designate a lead deputy state fire marshal aligned with each of the department’s survey teams and provide orientation that includes participation in at least one urban and one rural complete licensing inspection. In cities with comprehensive building codes meeting state minimums, the paid local fire chief must inspect jointly with the state and jointly approve premises before a full license is issued. The bill adds a definition of "condition-level violation" for RCW 70.41.080 as a level of noncompliance that does not present immediate jeopardy but limits the hospital’s capacity to provide safe and effective care and otherwise does not substantially meet licensing requirements. The term "immediate jeopardy" is referenced by citation to RCW 70.41.020 but its text is not included here. The changes are modifications to existing law and mainly affect inspection procedures, interagency coordination, and definitions used in enforcement; the extracted text does not show any new crimes or penalty changes. The specific state department referred to as "the department," the exact content of the cited RCW sections (70.41.020 and 70.41.155), and the criteria or identities of "department-recognized and approved accrediting bodies" are not specified in the provided facts.

Hospitals will face more routine, unannounced oversight: most hospitals can expect an unannounced inspection at least every 18 months unless they can show they passed an equivalent CMS or department-approved accreditation survey, in which case inspections drop to every 36 months. That means hospitals will need to collect and provide accreditation/certification proof within 30 days of survey results, make accreditor reports available on request, set aside time for a required follow-up meeting with an inspector, and respond to any information requests within a two-week window after an inspection. Fire safety checks will be more tightly coordinated with state and local fire officials, with paid local fire chiefs in cities that meet the state code joining state inspectors and jointly approving facilities before full licensing; serious or condition-level problems can trigger reinspections, and inspections can be paused during declared emergencies though patient-well-being investigations must continue. State and local agencies will have added coordination and training duties: the inspection program must notify the state fire marshal and local agencies four weeks ahead, share reports, and the state fire patrol must orient designated deputy marshals and align them with regional survey teams, which will add administrative and training work. For hospitals, choosing recognized accreditation is a practical option to reduce inspection frequency but shifts staff time to documentation and accreditor engagement; local fire departments and the state patrol will see increased inspection responsibilities and training costs. It is unclear from the provided facts which specific state department runs the hospital surveys and which accrediting bodies qualify, so the exact administrative and budget impacts cannot be fully determined.