Key Findings

1. Washington state has a strict regulatory process that restricts people’s access to health services called “certificate of need,” administered by Washington state’s Department of Health. 
2. States with certificate of need (CON) laws have higher health care costs and fewer medical services per capita. 
3. CON laws and regulations are harmful to patients. Congress repealed its CON law decades ago. A dozen states have followed suit. 
4. CON requirements reduce psychiatric services, and Washington state fails to meet a standard of having a minimum of 50 public psychiatric beds for every 100,000 people. A study from the Treatment Advocacy Center shows Washington state had just 13.3 beds per 100,000 people in 2023.
5. Senate Bill 5920, as originally constructed, would have lifted the CON required by the state to add psychiatric hospitals and beds.
6. The bill was amended. It would now only extend exemption legislation that was in place through June 2023.
7. Even in its watered-down form, a continued exemption of CON law on psychiatric hospitals and beds would improve troubling limitations on psychiatric services and help patients suffering from mental illness.

Introduction

Washington state has a limiting regulatory process that controls increased access to health services called “certificate of need.” It is administered by Washington state’s Department of Health (DOH). 

A hospital, health facility or nursing home that wants to expand or build to provide better services for patients must first apply for permission from the state and receive a certificate of need (CON) or exemption from DOH before proceeding, subject to certain exceptions and limitations. DOH charges a healthy fee for reviewing CON applications and applications for exemptions. The process can take months, delaying patient access to needed medical services.  

Federal and state officials originally thought that CON laws would cut the number of health care facilities in a specific area, avoid duplicative services and hopefully help control health care costs. States with CON laws, however, have higher health care costs and fewer medical services per capita. An overwhelming body of medical evidence shows that CON laws are a policy failure.

Given the demonstrable need for more psychiatric services in the state, the Legislature allowed exemptions from the CON requirement for increasing psychiatric beds within a hospital in 2014. The one-year exemption allowed was extended by the Legislature in 2017. It was also expanded to include construction, development, or establishment of psychiatric hospitals. Similar extensions were enacted in 2019 and 2021. The Department of Health’s ability to grant new CON exemptions related to these psychiatric services expired on June 30, 2023.

READ THE FULL LEGISLATIVE MEMO HERE