Washington State Introduces New Certificate of Need Fees for Healthcare Facilities

Washington state is changing what hospitals and other healthcare providers pay to seek approval for certain facilities and services. Effective October 10, 2026, most applications under its Certificate of Need program move from fixed review charges to a fee based on the proposed project’s estimated capital expenditure, with a $25,000 minimum and an $80,000 maximum.

The new calculation is 1.15% of estimated project capital spending. A separate $25,000 flat fee applies to qualifying projects in designated rural areas. The change could lower the initial review cost for some applications and raise it for others, depending on the facility category and size of the proposal.

The Washington Department of Health adopted the revised Certificate of Need fee rule on September 9, updating WAC 246-310-990. The program is distinct from ordinary hospital licensing: it requires state review of specific projects, such as establishing a new hospital, expanding certain bed capacity or introducing specified healthcare services. The rule changes the price of seeking that review, not the underlying legal test for whether a project needs approval.

Project spending replaces fixed charges for major facility reviews

The percentage-based schedule covers seven categories: hospitals, nursing homes, kidney disease treatment centers, ambulatory surgical centers and facilities, home health agencies, hospice agencies, and hospice care centers. The nursing-home category also includes continuing care retirement communities and transitional care units, as described in the adopted rule. The applicable fee is assessed for each facility or project type included in an application.

Previously, the state charged different flat amounts for different kinds of reviews. A hospital application carried a $40,470 fee, compared with $46,253 for nursing homes, $25,054 for kidney disease treatment centers and $20,427 for ambulatory surgical facilities. Home health agencies paid $24,666, hospice agencies $21,968 and hospice care centers $12,874 under the former schedule.

Under the new formula, a hypothetical nonrural project with $1 million in estimated capital expenditure would owe the $25,000 minimum because 1.15% of its spending falls below that floor. A $5 million project would generate a $57,500 application fee. For a $10 million project, the formula produces $115,000 before the cap, so the applicable fee would be limited to $80,000. These examples illustrate the calculation; they are not fees assessed against identified facilities.

That means two applicants proposing the same type of facility can now face different review charges. A relatively small hospital project may pay less than the old $40,470 hospital fee, whereas a larger one may pay more. The maximum also needs to be read carefully: because the rule provides for a fee for each facility or project type, it should not be understood as a universal $80,000 limit on every application involving multiple categories.

The charge is for the state review process rather than permission to proceed automatically. Washington’s Certificate of Need law identifies developments that must be reviewed, including the establishment of healthcare facilities, certain hospital sales or leases, increases in licensed bed capacity, new tertiary health services and additional dialysis stations. The revised fee rule does not make every construction project or routine operating change subject to Certificate of Need review.

Rural applications have a flat rate, but not every fee falls

For a facility project or project located in a designated rural area, the new application fee is $25,000 for each facility or project application. Rather than paying a percentage that rises with estimated spending, a qualifying rural applicant pays that stated amount. The rule directs applicants to the Department of Health for the criteria used to determine rural designation.

The department has described the rural provision as part of an effort to lower costs for rural applications. Whether a particular provider pays less than before, however, depends on its old fee category. A rural hospital that would previously have faced the $40,470 standard hospital review fee now has a $25,000 rural application rate. For a home health agency, the former standard fee was $24,666, slightly below the new rural amount. The rural treatment therefore should not be described as an across-the-board reduction from every old charge.

Other requests also receive new fixed fees. A determination of reviewability now costs $12,500, while an emergency review costs $9,500. The former schedule listed $8,286 for emergency reviews. An exemption request for an ambulatory surgical center is set at $18,000, and a rural hospital or rural healthcare facility exemption request is $3,000. Those exemption charges are separate from the main $25,000 rural application rate.

The rule also sets a $1,000 fee for a bed-banking extension and another $1,000 fee for extending the validity period of a Certificate of Need or replacement and renovation authorization. Such requests are not interchangeable with full applications, and the schedule specifies that exemption and extension review fees are nonrefundable.

Amendments, monitoring and refunds add to the budgeting decision

Applicants whose plans change during review may need to revisit what they owe. A request to amend a pending Certificate of Need application carries a nonrefundable $2,500 amendment fee. If the revised application produces a larger fee under the capital-expenditure calculation, the applicant must pay the difference when submitting the amendment. When recalculation produces a lower amount, the department refunds the decrease minus the amendment fee.

Amending a Certificate of Need that has already been issued is a different request, with a $15,000 nonrefundable fee. That compares with the former $12,874 charge for amendments to issued certificates. For projects subject to monitoring under the applicable rule, the department also imposes a $5,000 pre-project-completion monitoring fee at the fourth quarterly review after issuance, and again every fourth quarterly review until completion. It is not a yearly charge automatically imposed on every approved project.

Refunds on the principal application review fee depend on when a case ends. When the department returns an application under the specified provisions of its rules, 75% of the review fee is refunded. A withdrawal made before review begins likewise produces a 75% refund. Once review has started, but before the ex parte period begins, the refund falls to 50%. A withdrawal after the start of that period does not qualify for a refund of the review fee.

Those timing rules matter because the underlying application charge is no longer a fixed amount for most projects. A change in estimated capital spending can alter the fee calculation during an active review, while a late withdrawal can leave the applicant responsible for the full amount already paid. Providers assessing a new project will need to account for the applicable facility category, project budget, rural designation and any possible amendment or monitoring obligations.

The Department of Health said the overhaul is intended to support the operating costs of the Certificate of Need program. State law authorizes review and exemption fees and requires program costs to be covered. In explaining the rule, the department cited work such as technical assistance, public hearings, appeals and the development of review standards. It also said funding allocated during Washington’s 2026 legislative session allowed the final fee levels to be lower than amounts initially contemplated.

Washington filed the permanent rule on September 9 and set October 10 as its effective date. From that date, the revised application fee and the associated schedule of amendment, exemption, extension and monitoring charges provide the basis for what affected applicants pay when seeking state review.