BP BHEAD INT S

AN ACT Relating to the licensure of ambulatory surgical centers; adding a new chapter to Title 70 RCW; prescribing penalties; providing an effective date; and declaring an emergency.

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

NEW SECTION. Sec. 1. The legislature finds that ambulatory surgical centers have provided the citizens of Washington state access to various routine surgical and similar invasive medical procedures not requiring hospitalization, resulting in reduced health care costs consistent with the intent of health care reform. However, the delivery of these services may put patients at risk due to the invasive nature of the procedures performed and the short patient recovery time prior to discharge.

It is the intent of the legislature to protect the citizens of Washington state by licensing ambulatory surgical centers and by adopting and enforcing minimum standards for ambulatory surgical centers. Standards established are intended to be the minimum necessary to ensure a safe environment for the performance of surgical procedures and to ensure safe and competent care of patients.

NEW SECTION. Sec. 2. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Ambulatory surgical center" means any distinct entity that operates exclusively for the purpose of performing surgical procedures to treat patients not requiring hospitalization except:

(a) A health care facility otherwise licensed and regulated by the department to provide surgical services; and

(b) A facility in the offices of licensed practitioners, whether for individual or group practice, if the privilege of using such a facility is not extended to licensed practitioners outside the individual or group practice, unless such facility requests licensure as an ambulatory surgical center and meets the requirements of this chapter and rules adopted under this chapter.

(2) "Department" means the department of health.

(3) "Licensed practitioner" means a physician licensed under chapter 18.57 or 18.71 RCW, podiatric physician and surgeon licensed under chapter 18.22 RCW, dentist licensed under chapter 18.32 RCW, or any other licensed health care professional authorized by Washington state law to perform surgical procedures.

(4) "Person" means an individual, firm, partnership, corporation, company, association, joint stock association, and the legal successor thereof.

(5) "Surgical procedure" means an invasive medical procedure that:

(a) Utilizes a knife, laser, cautery, cryogenics, or chemicals; and

(b) Removes, corrects, or facilitates the cure of a disease, process, or injury through that branch of medicine that treats diseases, injuries, and deformities by manual or operative methods.

NEW SECTION. Sec. 3. After June 30, 1996, no person shall advertise, operate, or maintain an ambulatory surgical center without first obtaining an ambulatory surgical center license from the department.

NEW SECTION. Sec. 4. An applicant for an ambulatory surgical center license shall:

(1) Submit to the department a written application on a form provided by the department, including a list of surgical procedures offered;

(2) Submit to the department for review and approval building plans for new construction, alterations, and additions to existing facilities prior to licensure and occupancy as prescribed by the department;

(3) Demonstrate ability to comply with this chapter and rules adopted under this chapter;

(4) Cooperate with the department during on-site surveys prior to licensure or renewal of licensure;

(5) Provide such proof as the department may require concerning organizational and governance structure, and the identity of the applicant, officers, directors, partners, managing employees, or owners of ten percent or more of the applicant's assets;

(6) Pay to the department a license fee and building plan review fee as prescribed by the department under the authority of RCW 43.70.110 and 43.70.250; and

(7) Provide any other information the department may reasonably require.

NEW SECTION. Sec. 5. If the department determines that an applicant complies with the provisions of this chapter and rules adopted under this chapter, the department shall issue a license to the applicant. A license, unless suspended or revoked, is effective for a period of two years, however an initial license is only effective for twelve months. The department shall conduct at least one on-site survey within each licensure period, except as provided for in section 9 of this act.

NEW SECTION. Sec. 6. The department shall establish and adopt such minimum standards and rules pertaining to the construction, maintenance, and operation of ambulatory surgical centers as are necessary for the safe and adequate care and treatment of patients. The department shall rescind, amend, or modify the rules as necessary.

NEW SECTION. Sec. 7. The department may, at any time, conduct an on-site survey of a licensee in order to determine compliance with this chapter and rules adopted under this chapter.

NEW SECTION. Sec. 8. The department may deny, suspend, or revoke a license under this chapter or, in lieu thereof or in addition thereto, assess civil monetary penalties in any case in which it finds the applicant or licensee:

(1) Failed or refused to comply with the requirements of this chapter or rules adopted under this chapter;

(2) Was the holder of a license issued according to this chapter that was revoked for cause and never reissued by the department, or that was suspended for cause and the terms of the suspension were not fulfilled, and the licensee has continued to operate;

(3) Has knowingly or with reason to know made a false statement of material fact in the application for the license or any data attached thereto or in any record required by this chapter or matter under investigation by the department;

(4) Refused to allow representatives of the department to inspect any portion of the licensee's premises, or any book, record, or file required by this chapter to be maintained;

(5) Willfully prevented, interfered with, or attempted to impede in any way the work of any representative of the department and the lawful enforcement of any provision of this chapter;

(6) Willfully prevented, interfered with, or attempted to impede in any way any representative of the department in the preservation of evidence of any violation of this chapter or rules adopted under this chapter;

(7) Failed to pay any civil monetary penalty assessed by the department according to this chapter within ten days after the assessment becomes final;

(8) Used advertising that is false, fraudulent, or misleading;

(9) Has repeated incidents of personnel performing services beyond their scope of practice; or

(10) Misrepresented or was fraudulent in any aspect of the conduct of the licensee's business.

NEW SECTION. Sec. 9. (1) An ambulatory surgical center that is certified or accredited as an ambulatory surgical center by the federal medicare program, the joint commission on accreditation of health care organizations, or any other accrediting organization approved by the department, shall be granted the applicable renewal license without the necessity of an on-site state licensure survey if:

(a) The department determines that the applicable survey standards of the certification or accreditation program are substantially equivalent to those required by this chapter;

(b) An on-site survey has been conducted for the purposes of certification or accreditation during the previous twenty-four months; and

(c) The department receives directly from the certifying or accrediting entity or from the licensee or applicant copies of the initial and subsequent survey reports and other relevant reports or findings that indicate compliance with licensure requirements.

(2) In reviewing whether the federal medicare program, the joint commission on accreditation of health care organizations, or any other department-approved accrediting organization has survey standards that are of substantial equivalency to those set forth in this chapter, the department is directed to provide the most liberal interpretation consistent with the intent of this chapter. In the event the department determines at any time that the survey standards are not substantially equivalent to those required by this chapter, the department is directed to notify the affected licensees. The notification shall contain a detailed description of the deficiencies in the alternative survey process, as well as an explanation concerning the risk to the consumer. The determination of substantial equivalency for an alternative survey process and lack of substantial equivalency are agency actions and subject to the provisions of chapter 34.05 RCW.

(3) Ambulatory surgical centers receiving a license without an on-site survey by the department under this chapter shall pay the same licensure fee as other ambulatory surgical centers.

(4) This section does not affect the department's enforcement authority for licensed ambulatory surgical centers.

NEW SECTION. Sec. 10. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.

NEW SECTION. Sec. 11. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect July 1, 1995.

NEW SECTION. Sec. 12. Sections 1 through 10 of this act shall constitute a new chapter in Title 70 RCW.