WAC 246-310-010
Definitions. For the purposes of
chapter 246-310 WAC, the following words and phrases have the
following meanings unless the context clearly indicates
otherwise.
(1) "Acute care facilities" means hospitals and
ambulatory surgical facilities.
(2) "Affected person" means an interested person who:
(a) Is located or resides in the applicant's health
service area;
(b) Testified at a public hearing or submitted written
evidence; and
(c) Requested in writing to be informed of the
department's decision.
(3) "Alterations," see "construction, renovation, or
alteration."
(4) "Ambulatory care facility" means any place, building,
institution, or distinct part thereof not a health care
facility as defined in this section and operated for the
purpose of providing health services to individuals without
providing such services with board and room on a continuous
twenty-four-hour basis. The term "ambulatory care facility"
includes the offices of private physicians, whether for
individual or group practice.
(5) "Ambulatory surgical facility" means any
free-standing entity, including an ambulatory surgery center
that operates primarily for the purpose of performing surgical
procedures to treat patients not requiring hospitalization. This term does not include a facility in the offices of
private physicians or dentists, whether for individual or
group practice, if the privilege of using the facility is not
extended to physicians or dentists outside the individual or
group practice.
(6) "Applicant," means:
(a) Any person proposing to engage in any undertaking
subject to review under chapter 70.38 RCW; or
(b) Any person or individual with a ten percent or
greater financial interest in a partnership or corporation or
other comparable legal entity engaging in any undertaking
subject to review under chapter 70.38 RCW.
(7) "Bed banking" means the process of retaining the
rights to nursing home bed allocations which are not licensed
as outlined in WAC 246-310-395.
(8) "Bed supply" means within a geographic area the total
number of:
(a) Nursing home beds which are licensed or certificate
of need approved but not yet licensed or beds banked under RCW 70.38.111 (8)(a) or where the need is deemed met under RCW 70.38.115 (13)(b), excluding:
(i) Those nursing home beds certified as intermediate
care facility for the mentally retarded (ICF-MR) the operators
of which have not signed an agreement on or before July 1,
1990, with the department of social and health services
department of social and health services to give appropriate
notice prior to termination of the ICF-MR service;
(ii) New or existing nursing home beds within a CCRC
which are approved under WAC 246-310-380(5); or
(iii) Nursing home beds within a CCRC which is excluded
from the definition of a health care facility per RCW 70.38.025(6); and
(iv) Beds banked under RCW 70.38.115 (13)(b) where the
need is not deemed met.
(b) Licensed hospital beds used for long-term care or
certificate of need approved hospital beds to be used for
long-term care not yet in use, excluding swing-beds.
(9) "Bed-to-population ratio" means the nursing home bed
supply per one thousand persons of the estimated or forecasted
resident population age seventy and older.
(10) "Capital expenditure": Except for WAC 246-310-280,
capital expenditure means an expenditure, including a force
account expenditure (i.e., an expenditure for a construction
project undertaken by a nursing home facility as its own
contractor), which, under generally accepted accounting
principles, is not properly chargeable as an expense of
operation or maintenance. The costs of any studies, surveys,
designs, plans, working drawings, specifications, and other
activities (including staff effort, consulting and other
services which, under generally accepted accounting
principles, are not properly chargeable as an expense of
operation and maintenance) shall be considered capital
expenditures. Where a person makes an acquisition under lease
or comparable arrangement, or through donation, which would
have required certificate of need review if the acquisition
had been made by purchase, this acquisition shall be deemed a
capital expenditure. Capital expenditures include donations
of equipment or facilities to a nursing home facility, which
if acquired directly by the facility, would be subject to
review under this chapter and transfer of equipment or
facilities for less than fair market value if a transfer of
the equipment or facilities at fair market value would be
subject to the review.
(11) "Certificate of need" means a written authorization
by the secretary's designee for a person to implement a
proposal for one or more undertakings.
(12) "Certificate of need program" means that
organizational program of the department responsible for the
management of the certificate of need program.
(13) "Commencement of the project" means whichever of the
following occurs first: In the case of a construction
project, giving notice to proceed with construction to a
contractor for a construction project provided applicable
permits have been applied for or obtained within sixty days of
the notice; beginning site preparation or development;
excavating or starting the foundation for a construction
project; or beginning alterations, modification, improvement,
extension, or expansion of an existing building. In the case
of other projects, initiating a health service.
(14) "Construction, renovation, or alteration" means the
erection, building, remodeling, modernization, improvement,
extension, or expansion of a physical plant of a health care
facility, or the conversion of a building or portion thereof
to a health care facility.
(15) "Continuing care contract" means a contract
providing a person, for the duration of that person's life or
for a term in excess of one year, shelter along with nursing,
medical, health-related, or personal care services. The
contract is conditioned on the transfer of property, the
payment of an entrance fee to the provider of the services, or
the payment of periodic charges for the care and services
involved. A continuing care contract is not excluded from
this definition because the contract is mutually terminable or
because shelter and services are not provided at the same
location.
(16) "Continuing care retirement community (CCRC)" means
any of a variety of entities, unless excluded from the
definition of health care facility under RCW 70.38.025(6),
which provides shelter and services based on continuing care
contracts with its residents which:
Maintains for a period in excess of one year a CCRC
contract with a resident which provides or arranges for at
least the following specific services:
(a) Independent living units;
(b) Nursing home care with no limit on the number of
medically needed days;
(c) Assistance with activities of daily living;
(d) Services equivalent in scope to either state chore
services or medicaid home health services;
(e) Continues a contract, if a resident is no longer able
to pay for services;
(f) Offers services only to contractual residents with
limited exception during a transition period; and
(g) Holds the medicaid program harmless from liability
for costs of care, even if the resident depletes his or her
personal resources.
(17) "Days" means calendar days. Days are counted
starting the day after the date of the event from which the
designated period of time begins to run. If the last day of
the period falls on a Saturday, Sunday, or legal holiday
observed by the state of Washington, a designated period runs
until the end of the first working day following the Saturday,
Sunday, or legal holiday.
(18) "Department" means the Washington state department
of health.
(19) "Effective date of facility closure" means:
(a) The date on which the facility's license was
relinquished, revoked or expired; or
(b) The date the last resident leaves the facility,
whichever comes first.
(20) "Enhance the quality of life for residents" means,
for the purposes of voluntary bed banking, those services or
facility modifications which have a direct and immediate
benefit to the residents. These include, but are not limited
to: Resident activity and therapy facilities; family visiting
rooms; spiritual rooms and dining areas. These services or
facility modifications shall not include those that do not
have direct and immediate benefit to the residents, such as:
Modifications to staff offices; meeting rooms; and other staff
facilities.
(21) "Established ratio" means a bed-to-population ratio
of forty beds per one thousand persons of the estimated or
forecast resident population age seventy and older established
for planning and policy-making purposes. The department may
revise this established ratio using the process outlined in
WAC 246-310-370.
(22) "Estimated bed need" means the number of nursing
home beds calculated by multiplying the planning area's
forecasted resident population by the established ratio for
the projection year.
(23) "Estimated bed projection" means the number of
nursing home beds calculated by the department statewide or
within a planning area, by the end of the projection period.
(24) "Ex parte contact" means any oral or written
communication between any person in the certificate of need
program or any other person involved in the decision regarding
an application for, or the withdrawal of, a certificate of
need and the applicant for, or holder of, a certificate of
need, any person acting on behalf of the applicant or holder,
or any person with an interest regarding issuance or
withdrawal of a certificate of need.
(25) "Expenditure minimum" means one million dollars for
the twelve-month period beginning with July 24, 1983, adjusted
annually by the department according to WAC 246-310-900.
(26) "Health care facility" means hospitals, psychiatric
hospitals, nursing homes, kidney disease treatment centers
including freestanding dialysis units, ambulatory surgical
facilities, continuing care retirement communities, hospices
and home health agencies, and includes the facilities when
owned and operated by a political subdivision or
instrumentality of the state and other facilities as required
by federal law and rules, but does not include any health
facility or institution conducted by and for those who rely
exclusively upon treatment by prayer or spiritual means in
accordance with the creed or tenets of any well-recognized
church or religious denomination, or any health facility or
institution operated for the exclusive care of members of a
convent as defined in RCW 84.36.800 or rectory, monastery, or
other institution operated for the care of members of the
clergy.
(a) In addition, the term "health care facility" does not
include any nonprofit hospital:
(i) Operated exclusively to provide health care services
for children;
(ii) Which does not charge fees for the services; and
(iii) If not contrary to federal law as necessary to the
receipt of federal funds by the state.
(b) In addition, the term "health care facility" does not
include a continuing care retirement community which:
(i) Offers services only to contractual residents;
(ii) Provides its residents a contractually guaranteed
range of services from independent living through skilled
nursing, including some form of assistance with activities of
daily living;
(iii) Contractually assumes responsibility for costs of
services exceeding the resident's financial responsibility as
stated in contract, so that, with the exception of insurance
purchased by the retirement community or its residents, no
third party, including the medicaid program, is liable for
costs of care even if the resident depletes personal
resources;
(iv) Offers continuing care contracts and operates a
nursing home continuously since January 1, 1988, or obtained a
certificate of need to establish a nursing home;
(v) Maintains a binding agreement with the department of
social and health services assuring financial liability for
services to residents, including nursing home services, shall
not fall upon the department of social and health services;
(vi) Does not operate, and has not undertaken, a project
resulting in a number of nursing home beds in excess of one
for every four living units operated by the continuing care
retirement community, exclusive of nursing home beds; and
(vii) Has undertaken no increase in the total number of
nursing home beds after January 1, 1988, unless a professional
review of pricing and long-term solvency was obtained by the
retirement community within the prior five years and fully
disclosed to residents.
(27) "Health maintenance organization" means a public or
private organization, organized under the laws of the state,
which:
(a) Is a qualified health maintenance organization under
Title XIII, Section 1310(d) of the Public Health Service Act;
or
(b) Provides or otherwise makes available to enrolled
participants health care services, including at least the
following basic health care services: Usual physician
services, hospitalization, laboratory, X ray, emergency and
preventive services, and out-of-area coverage;
(c) Is compensated (except for copayments) for the
provision of the basic health care services listed in this
subsection to enrolled participants by a payment made on a
periodic basis without regard to the date the health care
services are provided and fixed without regard to the
frequency, extent, or kind of health service actually
provided; and
(d) Provides physicians' services primarily:
(i) Directly through physicians who are either employees
or partners of the organization; or
(ii) Through arrangements with individual physicians or
one or more groups of physicians (organized on a group
practice or individual practice basis).
(28) "Health service area" means a geographic region
appropriate for effective health planning including a broad
range of health services.
(29) "Health services" means clinically related (i.e.,
preventive, diagnostic, curative, rehabilitative, or
palliative) services and includes alcoholism, drug abuse, and
mental health services.
(30) "Home health agency" means an entity which is, or
has declared its intent to become, certified as a provider of
home health services in the medicaid or medicare program.
(31) "Hospice" means an entity which is, or has declared
its intent to become, certified as a provider of hospice
services in the medicaid or medicare program.
(32) "Hospital" means any institution, place, building or
agency or distinct part thereof which qualifies or is required
to qualify for a license under chapter 70.41 RCW, or as a
psychiatric hospital licensed under chapter 71.12 RCW.
(33) "Inpatient" means a person receiving health care
services with board and room in a health care facility on a
continuous twenty-four-hour-a-day basis.
(34) "Interested persons" means:
(a) The applicant;
(b) Health care facilities and health maintenance
organizations providing services similar to the services under
review and located in the health service area;
(c) Third-party payers reimbursing health care facilities
in the health service area;
(d) Any agency establishing rates for health care
facilities and health maintenance organizations in the health
service area where the proposed project is to be located;
(e) Health care facilities and health maintenance
organizations which, in the twelve months prior to receipt of
the application, have submitted a letter of intent to provide
similar services in the same planning area;
(f) Any person residing within the geographic area to be
served by the applicant; and
(g) Any person regularly using health care facilities
within the geographic area to be served by the applicant.
(35) "Licensee" means an entity or individual licensed by
the department of health or the department of social and
health services. For the purposes of nursing home projects,
licensee refers to the operating entity and those persons
specifically named in the license application as defined under
chapter 388-97 WAC.
(36) "Net estimated bed need" means estimated bed need of
a planning area changed by any redistribution as follows:
(a) Adding nursing home beds being redistributed from
another nursing home planning area or areas; or
(b) Subtracting nursing home beds being redistributed to
another nursing home planning area or areas.
(37) "New nursing home bed" means a nursing home bed
never licensed by the state or beds banked under RCW 70.38.115(13), where the applicant must demonstrate need for
the previously licensed nursing home beds. This term does not
include beds banked under RCW 70.38.111(8).
(38) "Nursing home" means any entity licensed or required
to be licensed under chapter 18.51 RCW or distinct part
long-term care units located in a hospital and licensed under
chapter 70.41 RCW.
(39) "Obligation," when used in relation to a capital
expenditure, means the following has been incurred by or on
behalf of a health care facility:
(a) An enforceable contract has been entered into by a
health care facility or by a person on behalf of the health
care facility for the construction, acquisition, lease, or
financing of a capital asset; or
(b) A formal internal commitment of funds by a health
care facility for a force account expenditure constituting a
capital expenditure; or
(c) In the case of donated property, the date on which
the gift is completed in accordance with state law.
(40) "Offer," when used in connection with health
services, means the health facility provides one or more
specific health services.
(41) "Over the established ratio" means the
bed-to-population ratio is greater than the statewide current
established ratio.
(42) "Person" means an individual, a trust or estate, a
partnership, a corporation (including associations, joint
stock companies, and insurance companies), the state, or a
political subdivision or instrumentality of the state,
including a municipal corporation or a hospital district.
(43) "Planning area" means each individual county
designated by the department as the smallest geographic area
for which nursing home bed need projections are developed,
except as follows:
(a) Clark and Skamania counties shall be one planning
area.
(b) Chelan and Douglas counties shall be one planning
area.
(44) "Predevelopment expenditures" means capital
expenditures, the total of which exceeds the expenditure
minimum, made for architectural designs, plans, drawings, or
specifications in preparation for the acquisition or
construction of physical plant facilities. "Predevelopment
expenditures" exclude any obligation of a capital expenditure
for the acquisition or construction of physical plant
facilities and any activity which the department may consider
the "commencement of the project" as this term is defined in
this section.
(45) "Professional review of continuing care retirement
community pricing and long-term solvency" means prospective
financial statements, supported by professional analysis and
documentation, which:
(a) Conform to Principles and Practices Board Statement
Number 9 of the Healthcare Financial Management Association,
"Accounting and Reporting Issues Related to Continuing Care
Retirement Communities"; and
(b) Project the financial operations of the continuing
care retirement community over a period of ten years or more
into the future; and
(c) Are prepared and signed by a qualified actuary as
defined under WAC 284-05-060 or an independent certified
public accountant, or are prepared by management of the
continuing care retirement community and reviewed by a
qualified actuary or independent certified public accountant
who issues a signed examination or compilation report on the
prospective financial statements; and
(d) Include a finding by management that the intended
expansion project of the continuing care retirement project is
financially feasible.
(46) "Project" means all undertakings proposed in a
single certificate of need application or for which a single
certificate of need is issued.
(47) "Project completion" for projects requiring
construction, means the date the facility is licensed. For
projects not requiring construction, project completion means
initiating the health service.
(48) "Projection period" means the three-year time
interval following the projection year.
(49) "Projection year" for nursing home purposes, means
the one-year time interval preceding the projection period.
(50) "Public comment period" means the time interval
during which the department shall accept comments regarding a
certificate of need application.
(51) "Redistribution" means the shift of nursing home bed
allocations between two or more planning areas or the shift of
nursing home beds between two or more nursing homes.
(52) "Replacement authorization" means a written
authorization by the secretary's designee for a person to
implement a proposal to replace existing nursing home beds in
accordance with the eligibility requirements in WAC 246-310-044 and notice requirements in WAC 246-310-396.
(53) "Resident population" for purposes of nursing home
projects, means the number of residents sixty-five years of
age and older living within the same geographic area which:
(a) Excludes contract holders living within a recognized
CCRC:
(i) With approval for new nursing home beds under WAC 246-310-380(4); or
(ii) Excluded from the definition of a health care
facility per RCW 70.38.025(6);
(b) Is calculated using demographic data obtained from:
(i) The office of financial management; and
(ii) Certificate of need applications and exemption
requests previously submitted by a CCRC.
(54) "Secretary" means the secretary of the Washington
state department of health or the secretary's designee.
(55) "State Health Planning and Resources Development
Act" means chapter 70.38 RCW.
(56) "Statewide current ratio" means a bed-to-population
ratio computed from the most recent statewide nursing home bed
supply and the most recent estimate of the statewide resident
population.
(57) "Swing beds" means up to the first five hospital
beds designated by an eligible rural hospital which are
available to provide either acute care or nursing home
services.
(58) "Tertiary health service" means a specialized
service meeting complicated medical needs of people and
requires sufficient patient volume to optimize provider
effectiveness, quality of service, and improved outcomes of
care.
(59) "Transition period" means the period of time, not
exceeding five years, between the date a CCRC is inhabited by
a member, and the date it fully meets the requirements of a
CCRC.
(60) "Under the established ratio" means the
bed-to-population ratio is less than the statewide current
established ratio.
(61) "Undertaking" means any action subject to the
provisions of chapter 246-310 WAC.
(62) "Working days" excludes Saturdays, Sundays, and
legal holidays observed by the state of Washington. Working
days are counted in the same way as calendar days.
[Statutory Authority: RCW 70.38.135. 08-19-018, §
246-310-010, filed 9/5/08, effective 10/6/08; 06-24-050, §
246-310-010, filed 12/1/06, effective 1/1/07. Statutory
Authority: Chapter 70.38 RCW. 04-17-054, § 246-310-010,
filed 8/10/04, effective 9/10/04; 98-10-053, § 246-310-010,
filed 4/29/98, effective 5/30/98; 96-24-052, § 246-310-010,
filed 11/27/96, effective 12/28/96. Statutory Authority: RCW 70.38.135 and 70.38.919. 92-02-018 (Order 224), §
246-310-010, filed 12/23/91, effective 1/23/92. Statutory
Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified
as § 246-310-010, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.38 RCW. 90-17-086 (Order
081), § 248-19-220, filed 8/17/90, effective 9/17/90;
90-02-093 (Order 023), § 248-19-220, filed 1/3/90, effective
2/3/90. Statutory Authority: RCW 70.38.135. 88-15-021
(Order 2639), § 248-19-220, filed 7/11/88; 86-06-030 (Order
2344), § 248-19-220, filed 2/28/86; 84-07-014 (Order 2082), §
248-19-220, filed 3/14/84; 81-09-012 (Order 210), §
248-19-220, filed 4/9/81, effective 5/20/81. Statutory
Authority: Chapter 70.38 RCW. 79-12-079 (Order 188), §
248-19-220, filed 11/30/79.]