AN ACT Relating to air and land ambulance services; amending RCW 70.38.105; creating new sections; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. The legislature finds that the recent proliferation of costly helicopter and air ambulance services by, or on behalf of, hospitals nationally and in this state may not be consonant with the provision of quality emergency care services for severely injured patients needing intensive care. These services are not being accomplished in the most cost-effective manner, leading to heavy hospital cross-subsidization of uneconomic services and cost-spiraling competition among hospitals for patients. The question of safety and the potential for air disasters, especially in urban areas, along with environmental and land use concerns contribute to the complexity of the problem. Air ambulance services are important life savers for those patients who are being dispatched to regionalized tertiary care hospitals. There is no definitive state policy in the state health plan for directing and monitoring the growth of this recent phenomenon. The legislature declares that providing economic air and related ambulance services by hospitals should be included in the state health planning process for the orderly development of an efficient and rational emergency care service system.

NEW SECTION. Sec. 2. By January 1, 1987, the state health coordinating council in cooperation with the regional health councils and emergency service councils shall include as part of the biennial state health plan an assessment of the need for air and land ambulance services as a health service undertaken by or on behalf of health care facilities within the health service areas.

NEW SECTION. Sec. 3. The department shall not grant a certificate-of-need to any applicant for an ambulance service covered by this chapter until the state health plan contains an assessment of the need for air and land ambulance services.

Sec. 4. Section 10, chapter 161, Laws of 1979 ex. sess. as last amended by section 21, chapter 288, Laws of 1984 and RCW 70.38.105 are each amended to read as follows:

(1) The department is authorized and directed to implement the certificate of need program in this state pursuant to the provisions of this chapter.

(2) There shall be a state certificate of need program which is administered consistent with the requirements of federal law as necessary to the receipt of federal funds by the state.

(3) No person shall engage in any undertaking which is subject to certificate of need review under subsection (4) of this section without first having received from the department either a certificate of need or an exception granted in accordance with this chapter.

(4) The following shall be subject to certificate of need review under this chapter:

(a) The construction, development, or other establishment of a new health care facility;

(b) The sale, purchase, or lease of part or all of any existing hospital as defined in RCW 70.39.020;

(c) Any capital expenditure by or on behalf of a health care facility which substantially changes the services of the facility after January 1, 1981, provided that the substantial changes in services are specified by the department in rule;

(d) Any capital expenditure by or on behalf of a health care facility which exceeds the expenditure minimum as defined by RCW 70.38.025. However, a capital expenditure which is not subject to certificate of need review under (a), (b), (c), (e), (f), or (g) of this subsection and which is solely for any one or more of the following is not subject to certificate of need review except to the extent required by the federal government as a condition to receipt of federal assistance and does not substantially affect patient charges:

(i) Communications and parking facilities;

(ii) Mechanical, electrical, ventilation, heating, and air conditioning systems;

(iii) Energy conservation systems;

(iv) Repairs to, or the correction of, deficiencies in existing physical plant facilities which are necessary to maintain state licensure;

(v) Acquisition of equipment, including data processing equipment, which is not or will not be used in the direct provision of health services;

(vi) Construction which involves physical plant facilities, including administrative and support facilities, which are not or will not be used for the provision of health services;

(vii) Acquisition of land; and

(viii) Refinancing of existing debt;

(e) A change in bed capacity of a health care facility which increases the total number of licensed beds or redistributes beds among facility and service categories of acute care, skilled nursing, intermediate care, and boarding home care if the bed redistribution is to be effective for a period in excess of six months;

(f) Acquisition of major medical equipment:

(i) If the equipment will be owned by or located in a health care facility; or

(ii) If, after January 1, 1981, the equipment is not to be owned by or located in a health care facility, the department finds consistent with federal regulations the equipment will be used to provide services for hospital inpatients, or the person acquiring such equipment did not notify the department of the intent to acquire such equipment at least thirty days before entering into contractual arrangements for such acquisition;

(g) Any new institutional health services which are offered in or through a health care facility, and which were not offered on a regular basis by, in, or through such health care facility within the twelve-month period prior to the time such services would be offered; ((~~and~~))

(h) Any expenditure by or on behalf of a health care facility in excess of the expenditure minimum made in preparation for any undertaking under subsection (4) of this section and any arrangement or commitment made for financing such undertaking. Expenditures of preparation shall include expenditures for architectural designs, plans, working drawings, and specifications. The department may issue certificates of need permitting predevelopment expenditures, only, without authorizing any subsequent undertaking with respect to which such predevelopment expenditures are made; and

(i) The establishment or expansion of an air or land ambulance service, including the following:

(i) Establishment of a new service;

(ii) Acquisition or operation of additional air or land ambulance vehicles; and

(iii) Construction of landing facilities.

(5) The operation of every air and land ambulance service for which a certificate-of-need is granted pursuant to this chapter shall be monitored periodically by the department to determine whether such service remains consistent with the terms of such certificate-of-need.

(6) No person may divide a project in order to avoid review requirements under any of the thresholds specified in this section.

NEW SECTION. Sec. 5. This 1986 act does not apply to the construction of emergency landing facilities by any regional tertiary care hospital that made an application for a conditional land use permit prior to December 1, 1984.

NEW SECTION. Sec. 6. This act is necessary for the immediate preservation of the public peace, health, and safety, the support of the state government and its existing public institutions, and shall take effect immediately.