This bill reenacts and amends RCW 70.38.111 and changes certificate-of-need procedures by creating and clarifying several exemptions and administrative timelines. It expressly exempts on-site dialysis services provided to residents of a skilled nursing facility from certificate-of-need requirements, and it reenacts and modifies existing exemptions for inpatient tertiary services offered by HMOs and related entities, nursing homes owned by continuing care retirement communities that meet specified conditions, certain hospice agencies meeting narrow criteria, ambulatory surgical facilities that met pre-2018 conditions, rural health clinics in designated home health shortage areas, hospital-at-home services (per RCW 70.41.550), and small behavioral health hospitals (up to 16 beds) providing certain involuntary treatment services. It also continues a time-limited suspension (May 5, 2017 through June 30, 2028) of certificate-of-need requirements for hospitals changing licensed beds to increase psychiatric service capacity, with those exemptions valid for two years. The bill modifies procedural requirements for facility bed conversions and restorations. Licensees who voluntarily reduced nursing home beds must notify the department of health within 30 days of the license reduction to preserve conversion options, must give notice to the department of health and the department of social and health services before converting beds back (one year’s notice if construction is required, 90 days if not), and must complete conversions within four years (one additional four‑year extension for good cause). Voluntarily reduced beds that remain convertible are counted as available for need calculations. The department must approve or disapprove certain exemption applications within 30 days of receiving a completed application, and the text limits the term "construction" to projects expected to meet or exceed the chapter’s expenditure minimum (the specific dollar threshold is not included here). This is a procedural and regulatory change rather than a new crime or penalty change; it changes eligibility for certificate-of-need exemptions, imposes notice and timing requirements, and clarifies how certain facility transactions and conversions are treated. Some key contextual details are missing from the extracted text: the identity of “the department” is not always specified, the exact certificate-of-need exemption requirements referenced are not fully enumerated here, the expenditure minimum that defines "construction" is not stated, and a portion of subsection (9)(a) is cut off, so the full scope of that provision is uncertain.

If enacted, the bill makes it easier and faster for skilled nursing facilities to provide on-site dialysis to their residents by removing the need for a certificate of need for those services, treating them as home hemodialysis under CMS rules. That likely lowers the time and regulatory cost barrier for nursing homes and dialysis providers to set up on-site dialysis and may increase access for residents, but providers must still follow Medicare/CMS conditions and notify or seek approvals from state agencies; the department of health and DSHS will have new notice, application, and timing responsibilities tied to these and related bed-conversion exemptions. The bill also formalizes processes that let nursing homes restore beds they had voluntarily reduced (with specific notice deadlines, timelines to complete conversions, and limits on construction thresholds and extensions), creates narrow CON exemptions for certain hospice agencies, ambulatory surgical centers, rural clinics, hospital-at-home services, and limited psychiatric bed increases, and counts some voluntarily reduced beds in future need calculations. The practical effect shifts costs and delays away from certificate-of-need proceedings toward meeting notice, timing, and Medicare/department requirements; however, some implementation details are not fully shown in the extracted text (for example, which state “department” is referenced in every place and the exact expenditure minimum that defines “construction”), so a few operational responsibilities and thresholds remain uncertain.