BILL REQ. #:  S-2089.1 

READ FIRST TIME 03/05/03.   

     AN ACT Relating to coordinating and scheduling surveys and audits of hospitals and health care services and facilities operated or controlled by hospitals; amending RCW 18.20.110, 18.51.091, 43.09.260, 51.36.110, 69.41.270, 70.41.080, 70.41.120, 70.42.170, 70.62.250, 70.96A.090, 70.98.080, 70.98.090, 70.127.180, 70.168.070, 70.168.080, 71.12.480, 71.12.485, 71.12.500, and 74.09.200; adding a new section to chapter 18.64 RCW; adding a new section to chapter 43.09 RCW; adding a new section to chapter 43.20A RCW; adding a new section to chapter 43.21A RCW; adding a new section to chapter 43.22 RCW; adding a new section to chapter 43.70 RCW; adding a new section to chapter 70.175 RCW; adding a new section to chapter 74.39A RCW; adding a new section to chapter 82.01 RCW; adding a new chapter to Title 43 RCW; creating a new section; 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 and declares that it is in the interest of the public health and safety of patients to improve the regulatory environment for hospitals and affiliated health care services and facilities by requiring state agencies that survey hospitals and their affiliated health care services and facilities to coordinate the scheduling of surveys and audits, to provide advance notice of surveys and audits to hospitals, and to share information obtained during surveys and audits. Hospitals and their affiliated health care services and facilities are surveyed and audited by a myriad of federal, state, and local agencies, some being subject to more than a dozen different surveys or audits by state agencies, as well as being surveyed to be accredited by the joint commission on the accreditation of health care organizations. The legislature finds that hospitals, particularly those in rural communities, that provide a continuum of health care services including nursing homes, assisted living facilities, or ambulance services, all of which are subject to licensing surveys, will be better able to respond to surveys and audits, and implement suggested changes to improve the quality of patient care, if hospitals are not subject to simultaneous or back-to-back surveys or audits. Surveys and audits will be more cost-effective for hospitals and affiliated services and facilities if hospitals are not required to respond to multiple requests for the same information.

NEW SECTION.  Sec. 2   Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
     (1) "Agency" means a department of state government created under RCW 43.17.010 and the office of the state auditor.
     (2) "Audit" means an examination of records or financial accounts to evaluate accuracy and monitor compliance with statutory or regulatory requirements.
     (3) "Hospital" means a hospital licensed under chapter 70.41 RCW.
     (4) "Hospital services or facilities" means licensed or certified health care services or facilities operated or controlled by a hospital or an entity that operates a hospital, including ambulance services, assisted living facilities, boarding homes, chemical dependency or psychiatric facilities, home health services, hospice, nursing homes, pharmacies, and rural health clinics.
     (5) "Survey" means an inspection, examination, or site visit conducted by an agency to evaluate and monitor the compliance of a hospital or hospital services or facilities with statutory or regulatory requirements.

NEW SECTION.  Sec. 3   (1) Except as provided in subsection (2) of this section, an agency that conducts surveys or audits of hospitals or hospital services or facilities shall:
     (a) Coordinate the scheduling of all surveys and audits with programs of that agency and with other agencies and take into consideration surveys and audits scheduled by the joint commission on the accreditation of health care organizations and other nationally recognized accreditation organizations; and
     (b) Share information and documents provided by hospitals and hospital services and facilities pertaining to surveys and audits.
     (2) Subsection (1)(a) of this section does not apply to investigations and site visits not conducted as part of a regularly scheduled survey or audit that are: (a) In response to a complaint received by an agency; or (b) requested by a hospital.

NEW SECTION.  Sec. 4   (1) If an agency does not comply with the process designed under section 5 of this act, a hospital or hospital service or facility may refuse to allow the agency to conduct the survey or audit at the time selected by the agency and the agency must reschedule the audit or survey in accordance with the requirements of this chapter.
     (2) An agency may not retaliate against a hospital or hospital service or facility that refuses to allow the agency to conduct a survey or audit because the agency has not complied with the process designed under section 5 of this act.

NEW SECTION.  Sec. 5   (1) The department of health, with the participation of stakeholders and all other agencies that conduct surveys or audits of hospitals or hospital services or facilities, shall design a process to accomplish the requirements of section 3 of this act. For the purposes of this section, "stakeholders" means hospitals, hospital services and facilities controlled or operated by hospitals or entities that control or operate a hospital, and the Washington state hospital association.
     (2) The following agencies are required to actively and effectively participate in the design of the survey coordination process: State board of pharmacy; state auditor; chief of the Washington state patrol, through the director of fire protection; and the departments of health, social and health services, ecology, labor and industries, and revenue.
     (3) The process must establish:
     (a) A procedure for scheduling audits and surveys;
     (b) Standards for the frequency of audits and surveys;
     (c) A mechanism for resolving scheduling disputes that may arise between agencies;
     (d) A mechanism for resolving scheduling conflicts with hospital staff availability or planned hospital events;
     (e) A mechanism for addressing disputes that includes full assurance that advancing a dispute will not result in retaliation or punitive action against a hospital or hospital services or facilities;
     (f) Written notice requirements for scheduling audits and surveys unless notice is prohibited by state or federal law;
     (g) Requirements for and necessary limitations to sharing information and documents provided by hospitals and hospital services or facilities; and
     (h) Other provisions the agencies and stakeholders agree are necessary to implement the intent of this chapter.
     (4) The elements of the process that do not require legislative changes take effect January 1, 2004.

NEW SECTION.  Sec. 6   The department of health shall prepare and present a report to the legislature no later than October 1, 2003, describing the process designed under section 5 of this act and identifying any legislative changes necessary to implement the process.

NEW SECTION.  Sec. 7   A new section is added to chapter 18.64 RCW to read as follows:
     The board of pharmacy shall coordinate and schedule surveys, audits, and inspections of hospitals licensed under chapter 70.41 RCW and health care services or facilities operated or controlled by hospitals licensed under chapter 70.41 RCW in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

NEW SECTION.  Sec. 8   A new section is added to chapter 43.09 RCW to read as follows:
     The auditor shall coordinate and schedule surveys, audits, and inspections of hospitals licensed under chapter 70.41 RCW and health care services or facilities operated or controlled by hospitals licensed under chapter 70.41 RCW in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

NEW SECTION.  Sec. 9   A new section is added to chapter 43.20A RCW to read as follows:
     The department of social and health services shall coordinate and schedule surveys, audits, and inspections of hospitals licensed under chapter 70.41 RCW and health care services or facilities operated or controlled by hospitals licensed under chapter 70.41 RCW in accordance with chapter 43-- RCW (sections 1 through 5 of this act).

NEW SECTION.  Sec. 10   A new section is added to chapter 43.21A RCW to read as follows:
     The department of ecology shall coordinate and schedule surveys, audits, and inspections of hospitals licensed under chapter 70.41 RCW and health care services or facilities operated or controlled by hospitals licensed under chapter 70.41 RCW in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

NEW SECTION.  Sec. 11   A new section is added to chapter 43.22 RCW to read as follows:
     The department of labor and industries shall coordinate and schedule surveys, audits, and inspections of hospitals licensed under chapter 70.41 RCW and health care services or facilities operated or controlled by hospitals licensed under chapter 70.41 RCW in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

NEW SECTION.  Sec. 12   A new section is added to chapter 43.70 RCW to read as follows:
     The department of health shall coordinate and schedule surveys, audits, and inspections of hospitals licensed under chapter 70.41 RCW and health care services or facilities operated or controlled by hospitals licensed under chapter 70.41 RCW in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

NEW SECTION.  Sec. 13   A new section is added to chapter 70.175 RCW to read as follows:
     The department of health shall coordinate and schedule any surveys, audits, or inspections of rural health care facilities in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

NEW SECTION.  Sec. 14   A new section is added to chapter 74.39A RCW to read as follows:
     The department of social and health services shall coordinate and schedule surveys, audits, and inspections of assisted living services, adult residential care services, or enhanced adult residential care services operated or controlled by a hospital licensed under chapter 70.41 RCW in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

NEW SECTION.  Sec. 15   A new section is added to chapter 82.01 RCW to read as follows:
     The department of revenue shall coordinate and schedule surveys, audits, and inspections of hospitals licensed under chapter 70.41 RCW and health care services or facilities operated or controlled by hospitals licensed under chapter 70.41 RCW in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

Sec. 16   RCW 18.20.110 and 2000 c 47 s 4 are each amended to read as follows:
     The department shall make or cause to be made at least a yearly inspection and investigation of all boarding homes. Inspections and investigations of boarding homes operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act). Every inspection shall focus primarily on actual or potential resident outcomes, and may include an inspection of every part of the premises and an examination of all records (other than financial records), methods of administration, the general and special dietary, and the stores and methods of supply. Following such an inspection or inspections, written notice of any violation of this law or the rules adopted hereunder shall be given to the applicant or licensee and the department. The department may prescribe by rule that any licensee or applicant desiring to make specified types of alterations or additions to its facilities or to construct new facilities shall, before commencing such alteration, addition, or new construction, submit plans and specifications therefor to the agencies responsible for plan reviews for preliminary inspection and approval or recommendations with respect to compliance with the rules and standards herein authorized.

Sec. 17   RCW 18.51.091 and 1987 c 476 s 24 are each amended to read as follows:
     The department shall make or cause to be made at least one inspection of each nursing home prior to license renewal and shall inspect community-based services as part of the licensing renewal survey. The inspection shall be made without providing advance notice of it. Inspections of nursing homes operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act). Every inspection may include an inspection of every part of the premises and an examination of all records, methods of administration, the general and special dietary and the stores and methods of supply. Those nursing homes that provide community-based care shall establish and maintain separate and distinct accounting and other essential records for the purpose of appropriately allocating costs of the providing of such care: PROVIDED, That such costs shall not be considered allowable costs for reimbursement purposes under chapter 74.46 RCW. Following such inspection or inspections, written notice of any violation of this law or ((the)) rules ((and regulations promulgated hereunder,)) shall be given the applicant or licensee and the department. The notice shall describe the reasons for the facility's noncompliance. The department may prescribe by ((regulations)) rule that any licensee or applicant desiring to make specified types of alterations or additions to its facilities or to construct new facilities shall, before commencing such alteration, addition or new construction, submit its plans and specifications therefor to the department for preliminary inspection and approval or recommendations with respect to compliance with the ((regulations)) rules and standards ((herein)) authorized.

Sec. 18   RCW 43.09.260 and 1995 c 301 s 15 are each amended to read as follows:
     The examination of the financial affairs of all local governments shall be made at such reasonable, periodic intervals as the state auditor shall determine. However, an examination of the financial affairs of all local governments shall be made at least once in every three years, and an examination of individual local government health and welfare benefit plans and local government self-insurance programs shall be made at least once every two years. The term local governments for purposes of this chapter includes but is not limited to all counties, cities, and other political subdivisions, municipal corporations, and quasi-municipal corporations, however denominated.
     The state auditor shall establish a schedule to govern the auditing of local governments which shall include: A designation of the various classifications of local governments; a designation of the frequency for auditing each type of local government; and a description of events which cause a more frequent audit to be conducted.
     Examinations of hospitals licensed under chapter 70.41 RCW and health care services and facilities operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).
     On every such examination, inquiry shall be made as to the financial condition and resources of the local government; whether the Constitution and laws of the state, the ordinances and orders of the local government, and the requirements of the state auditor have been properly complied with; and into the methods and accuracy of the accounts and reports.
     A report of such examination shall be made and filed in the office of state auditor, and one copy shall be transmitted to the local government. A copy of any report containing findings of noncompliance with state law shall be transmitted to the attorney general. If any such report discloses malfeasance, misfeasance, or nonfeasance in office on the part of any public officer or employee, within thirty days from the receipt of his or her copy of the report, the attorney general shall institute, in the proper county, such legal action as is proper in the premises by civil process and prosecute the same to final determination to carry into effect the findings of the examination.
     It shall be unlawful for any local government or the responsible head thereof, to make a settlement or compromise of any claim arising out of such malfeasance, misfeasance, or nonfeasance, or any action commenced therefor, or for any court to enter upon any compromise or settlement of such action, without the written approval and consent of the attorney general and the state auditor.

Sec. 19   RCW 51.36.110 and 1994 c 154 s 312 are each amended to read as follows:
     The director of the department of labor and industries or the director's authorized representative shall have the authority to:
     (1) Conduct audits and investigations of providers of medical, chiropractic, dental, vocational, and other health services furnished to industrially injured workers pursuant to Title 51 RCW. In the conduct of such audits or investigations, the director or the director's authorized representatives may examine all records, or portions thereof, including patient records, for which services were rendered by a health services provider and reimbursed by the department, notwithstanding the provisions of any other statute which may make or purport to make such records privileged or confidential((: PROVIDED, That no)). However, original patient records ((shall)) may not be removed from the premises of the health services provider, and that the disclosure of any records or information obtained under authority of this section by the department of labor and industries is prohibited and constitutes a violation of RCW 42.52.050, unless such disclosure is directly connected to the official duties of the department((: AND PROVIDED FURTHER, That)). The disclosure of patient information as required under this section shall not subject any physician or other health services provider to any liability for breach of any confidential relationships between the provider and the patient((: AND PROVIDED FURTHER, That)). The director or the director's authorized representative shall destroy all copies of patient medical records in their possession upon completion of the audit, investigation, or proceedings. Audits and investigations of hospitals licensed under chapter 70.41 RCW and health care services or facilities operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act);
     (2) Approve or deny applications to participate as a provider of services furnished to industrially injured workers pursuant to Title 51 RCW; and
     (3) Terminate or suspend eligibility to participate as a provider of services furnished to industrially injured workers pursuant to Title 51 RCW.

Sec. 20   RCW 69.41.270 and 1989 c 352 s 5 are each amended to read as follows:
     A pharmaceutical manufacturer, wholesaler, pharmacy, or practitioner who purchases, dispenses, or distributes legend drugs shall maintain invoices or such other records as are necessary to account for the receipt and disposition of the legend drugs.
     The records maintained pursuant to this section shall be available for inspection by the board and its authorized representatives and shall be maintained for two years. Inspections of pharmacies operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

Sec. 21   RCW 70.41.080 and 1995 c 369 s 40 are each amended to read as follows:
     Standards for fire protection and the enforcement thereof, with respect to all hospitals to be licensed ((hereunder)) under this chapter shall be the responsibility of the chief of the Washington state patrol, through the director of fire protection, who shall adopt, after approval by the department, such recognized standards as may be applicable to hospitals for the protection of life against the cause and spread of fire and fire hazards. The department upon receipt of an application for a license, shall submit to the director of fire protection in writing, a request for an inspection, giving the applicant's name and the location of the premises to be licensed. Upon receipt of such a request, the chief of the Washington state patrol, through the director of fire protection, or his or her deputy, shall make an inspection of the hospital to be licensed, and if it is found that the premises do not comply with the required safety standards and fire regulations as adopted pursuant to this chapter, he or she shall promptly make a written report to the hospital and to the department listing the corrective actions required and the time allowed for accomplishing such corrections. The applicant or licensee shall notify the chief of the Washington state patrol, through the director of fire protection, upon completion of any corrections required by him or her, and the chief of the Washington state patrol, through the director of fire protection, or his or her deputy, shall make a reinspection of such premises. Whenever the hospital to be licensed meets with the approval of the chief of the Washington state patrol, through the director of fire protection, he or she shall submit to the department a written report approving the hospital with respect to fire protection, and such report is required before a full license can be issued. The chief of the Washington state patrol, through the director of fire protection, shall make or cause to be made inspections of such hospitals at least once a year. Inspections must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).
     In cities which have in force a comprehensive building code, the provisions of which are determined by the chief of the Washington state patrol, through the director of fire protection, to be equal to the minimum standards of the code for hospitals adopted by the chief of the Washington state patrol, through the director of fire protection, the chief of the fire department, provided the latter is a paid chief of a paid fire department, shall make the inspection with the chief of the Washington state patrol, through the director of fire protection, or his or her deputy and they shall jointly approve the premises before a full license can be issued.

Sec. 22   RCW 70.41.120 and 1995 c 282 s 4 are each amended to read as follows:
     The department shall make or cause to be made at least yearly an inspection of all hospitals. Every inspection of a hospital may include an inspection of every part of the premises. The department may make an examination of all phases of the hospital operation necessary to determine compliance with the law and the standards((,)) and rules ((and regulations adopted thereunder)) adopted under the law. Any licensee or applicant desiring to make alterations or additions to its facilities or to construct new facilities shall, before commencing such alteration, addition, or new construction, comply with the ((regulations prescribed)) rules adopted by the department.
     No hospital licensed pursuant to the provisions of this chapter shall be required to be inspected or licensed under other state laws or rules ((and regulations promulgated thereunder)), or local ordinances, relative to hotels, restaurants, lodging houses, boarding houses, places of refreshment, nursing homes, maternity homes, or psychiatric hospitals.
     To avoid unnecessary duplication in inspections, the department shall coordinate with the department of social and health services when inspecting facilities over which both agencies have jurisdiction, the facilities including but not necessarily being limited to hospitals with both acute care and skilled nursing or psychiatric nursing functions. Surveys, inspections, and audits of hospitals must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

Sec. 23   RCW 70.42.170 and 1989 c 386 s 18 are each amended to read as follows:
     The department may at any time conduct an on-site review of a licensee or applicant in order to determine compliance with this chapter. However, an on-site review of test sites operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act). When the department has reason to believe a waivered site is conducting tests requiring a license, the department may conduct an on-site review of the waivered site in order to determine compliance. The department may also examine and audit records necessary to determine compliance with this chapter. The right to conduct an on-site review and audit and examination of records shall extend to any premises and records of persons whom the department has reason to believe are opening, owning, conducting, maintaining, managing, or otherwise operating a test site without a license.
     Following an on-site review, the department shall give written notice of any violation of this chapter or the rules adopted under this chapter. The notice shall describe the reasons for noncompliance and inform the licensee or applicant or test site operator that it shall comply within a specified reasonable time. If the licensee or applicant or test site operator fails to comply, the department may take disciplinary action under RCW 70.42.120 through 70.42.150, or further action as authorized by this chapter.

Sec. 24   RCW 70.62.250 and 1971 ex.s. c 239 s 6 are each amended to read as follows:
     The department is hereby granted and shall have and exercise, in addition to the powers herein granted, all the powers necessary and appropriate to carry out and execute the purposes of this chapter, including but not limited to the power:
     (1) To develop ((such)) rules ((and regulations)) for proposed adoption by the board as may be necessary to implement the purposes of this chapter;
     (2) To enter and inspect at any reasonable time any transient accommodation and to make such investigations as are reasonably necessary to carry out the provisions of this chapter and any rules ((and regulations promulgated thereunder: PROVIDED, That no)) adopted under this chapter. However, a room or suite ((shall)) may not be entered for inspection unless ((said)) the room or suite is not occupied by any patron or guest of the transient accommodation at the time of entry. Inspections of transient accommodations operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act);
     (3) To perform such other duties and employ such personnel as may be necessary to carry out the provisions of this chapter; and
     (4) To administer and enforce the provisions of this chapter and the rules ((and regulations promulgated thereunder)) adopted by the board.

Sec. 25   RCW 70.96A.090 and 1995 c 312 s 46 are each amended to read as follows:
     (1) The department shall adopt rules establishing standards for approved treatment programs, the process for the review and inspection program applying to the department for certification as an approved treatment program, and fixing the fees to be charged by the department for the required inspections. The standards may concern the health standards to be met and standards of services and treatment to be afforded patients.
     (2) The department may suspend, revoke, limit, restrict, or modify an approval, or refuse to grant approval, for failure to meet the provisions of this chapter, or the standards adopted under this chapter. RCW 43.20A.205 governs notice of a license denial, revocation, suspension, or modification and provides the right to an adjudicative proceeding.
     (3) No treatment program may advertise or represent itself as an approved treatment program if approval has not been granted, or has been denied, suspended, revoked, or canceled.
     (4) Certification as an approved treatment program is effective for one calendar year from the date of issuance of the certificate. The certification shall specify the types of services provided by the approved treatment program that meet the standards adopted under this chapter. Renewal of certification shall be made in accordance with this section for initial approval and in accordance with the standards set forth in rules adopted by the secretary.
     (5) Approved treatment programs shall not provide alcoholism or other drug addiction treatment services for which the approved treatment program has not been certified. Approved treatment programs may provide services for which approval has been sought and is pending, if approval for the services has not been previously revoked or denied.
     (6) The department periodically shall inspect approved public and private treatment programs at reasonable times and in a reasonable manner. Inspections of treatment programs operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).
     (7) The department shall maintain and periodically publish a current list of approved treatment programs.
     (8) Each approved treatment program shall file with the department on request, data, statistics, schedules, and information the department reasonably requires. An approved treatment program that without good cause fails to furnish any data, statistics, schedules, or information as requested, or files fraudulent returns thereof, may be removed from the list of approved treatment programs, and its certification revoked or suspended.
     (9) The department shall use the data provided in subsection (8) of this section to evaluate each program that admits children to inpatient treatment upon application of their parents. The evaluation shall be done at least once every twelve months. In addition, the department shall randomly select and review the information on individual children who are admitted on application of the child's parent for the purpose of determining whether the child was appropriately placed into treatment based on an objective evaluation of the child's condition and the outcome of the child's treatment.
     (10) Upon petition of the department and after a hearing held upon reasonable notice to the facility, the superior court may issue a warrant to an officer or employee of the department authorizing him or her to enter and inspect at reasonable times, and examine the books and accounts of, any approved public or private treatment program refusing to consent to inspection or examination by the department or which the department has reasonable cause to believe is operating in violation of this chapter.

Sec. 26   RCW 70.98.080 and 1984 c 96 s 1 are each amended to read as follows:
     (1) The agency shall provide by rule ((or regulation)) for general or specific licensing of byproduct, source, special nuclear materials, or devices or equipment utilizing such materials, or other radioactive material occurring naturally or produced artificially. Such rule ((or regulation)) shall provide for amendment, suspension, or revocation of licenses. Such rule ((or regulation)) shall provide that:
     (a) Each application for a specific license shall be in writing and shall state such information as the agency, by rule ((or regulation)), may determine to be necessary to decide the technical, insurance, and financial qualifications, or any other qualification of the applicant as the agency may deem reasonable and necessary to protect the occupational and public health and safety. The agency may at any time after the filing of the application, and before the expiration of the license, require further written statements and shall make such inspections as the agency deems necessary in order to determine whether the license should be granted or denied or whether the license should be modified, suspended, or revoked. In no event shall the agency grant a specific license to any applicant who has never possessed a specific license issued by a recognized state or federal authority until the agency has conducted an inspection which insures that the applicant can meet the rules((, regulations)) and standards adopted pursuant to this chapter. Inspection of hospitals licensed under chapter 70.41 RCW and health care services or facilities operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act). All applications and statements shall be signed by the applicant or licensee. The agency may require any applications or statements to be made under oath or affirmation;
     (b) Each license shall be in such form and contain such terms and conditions as the agency may by rule ((or regulation)) prescribe;
     (c) No license issued under the authority of this chapter and no right to possess or utilize sources of ionizing radiation granted by any license shall be assigned or in any manner disposed of; and
     (d) The terms and conditions of all licenses shall be subject to amendment, revision, or modification by rules((, regulations)) or orders issued in accordance with the provisions of this chapter.
     (2) Before the agency issues a license to an applicant under this section, it shall give notice of such application to the chief executive officer of the incorporated city or town, if the application is for a license within an incorporated city or town, or to the county legislative authority, if the application is for a license outside the boundaries of incorporated cities or towns. The incorporated city or town, through the official or employee selected by it, or the county legislative authority or the official or employee selected by it, shall have the right to file with the agency within twenty days after date of transmittal of such notice, written objections against the applicant or against the activity for which the license is sought, and shall include with such objections a statement of all facts upon which such objections are based, and in case written objections are filed, may request and the agency may in its discretion hold a formal hearing under chapter 34.05 RCW. Upon the granting of a license under this section the agency shall send a duplicate of the license or written notification to the chief executive officer of the incorporated city or town in which the license is granted, or to the county legislative authority if the license is granted outside the boundaries of incorporated cities or towns.
     This subsection shall not apply to activities conducted within the boundaries of the Hanford reservation.
     (3) The agency may require registration of all sources of ionizing radiation.
     (4) The agency may exempt certain sources of ionizing radiation or kinds of uses or users from the registration or licensing requirements set forth in this section when the agency makes a finding after approval of the technical advisory board that the exemption of such sources of ionizing radiation or kinds of uses or users will not constitute a significant risk to the health and safety of the public.
     (5) In ((promulgating rules and regulations pursuant to)) adopting rules under this chapter the agency shall, insofar as practical, strive to avoid requiring dual licensing, and shall provide for such recognition of other state or federal licenses as the agency shall deem desirable, subject to such registration requirements as the agency may prescribe.

Sec. 27   RCW 70.98.090 and 1985 c 372 s 2 are each amended to read as follows:
     The agency or its duly authorized representative shall have the power to enter at all reasonable times upon any private or public property for the purpose of determining whether or not there is compliance with or violation of the provisions of this chapter and rules ((and regulations issued thereunder)) adopted under this chapter. Inspection of hospitals licensed under chapter 70.41 RCW and health care services or facilities operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

Sec. 28   RCW 70.127.180 and 2000 c 175 s 15 are each amended to read as follows:
     (1) The department may at any time conduct a survey of all records and operations of a licensee in order to determine compliance with this chapter. The department may conduct in-home visits to observe patient/client care and services. The right to conduct a survey shall extend to any premises and records of persons whom the department has reason to believe are providing home health, hospice, or home care services without a license. Surveys of licensees operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).
     (2) Following a survey, the department shall give written notice of any violation of this chapter or the rules adopted under this chapter. The notice shall describe the reasons for noncompliance.
     (3) The licensee may be subject to formal enforcement action under RCW 70.127.170 if the department determines: (a) The licensee has previously been subject to a formal enforcement action for the same or similar type of violation of the same statute or rule, or has been given previous notice of the same or similar type of violation of the same statute or rule; (b) the licensee failed to achieve compliance with a statute, rule, or order by the date established in a previously issued notice or order; (c) the violation resulted in actual serious physical or emotional harm or immediate threat to the health, safety, welfare, or rights of one or more individuals; or (d) the violation has a potential for serious physical or emotional harm or immediate threat to the health, safety, welfare, or rights of one or more individuals.

Sec. 29   RCW 70.168.070 and 1990 c 269 s 9 are each amended to read as follows:
     Any hospital or health care facility that desires to be authorized to provide a designated trauma care service shall request designation from the department. Designation involves a contractual relationship between the state and a hospital or health care facility whereby each agrees to maintain a level of commitment and resources sufficient to meet responsibilities and standards required by the statewide emergency medical services and trauma care system plan. By January 1992, the department shall determine by rule the manner and form of such requests. Upon receiving a request, the department shall review the request to determine whether the hospital or health care facility is in compliance with standards for the trauma care service or services for which designation is desired. If requests are received from more than one hospital or health care facility within the same emergency medical planning and trauma care planning and service region, the department shall select the most qualified applicant or applicants to be selected through a competitive process. Any applicant not designated may request a hearing to review the decision.
     Designations are valid for a period of three years and are renewable upon receipt of a request for renewal prior to expiration from the hospital or health care facility. When an authorization for designation is due for renewal other hospitals and health care facilities in the area may also apply and compete for designation. Regional emergency medical and trauma care councils shall be notified promptly of designated hospitals and health care facilities in their region so they may incorporate them into the regional plan as required by this chapter. The department may revoke or suspend the designation should it determine that the hospital or health care facility is substantially out of compliance with the standards and has refused or been unable to comply after a reasonable period of time has elapsed. The department shall promptly notify the regional emergency medical and trauma care planning and service region of suspensions or revocations. Any facility whose designation has been revoked or suspended may request a hearing to review the action by the department as provided for in chapter 34.05 RCW.
     As a part of the process to designate and renew the designation of hospitals authorized to provide level I, II, or III trauma care services or level I, II, and III pediatric trauma care services, the department shall contract for on-site reviews of such hospitals to determine compliance with required standards. The department may contract for on-site reviews of hospitals and health care facilities authorized to provide level IV or V trauma care services or level I, I-pediatric, II, or III trauma-related rehabilitative services to determine compliance with required standards. Members of on-site review teams and staff included in site visits are exempt from RCW 42.17.250 through 42.17.450. They may not divulge and cannot be subpoenaed to divulge information obtained or reports written pursuant to this section in any civil action, except, after in camera review, pursuant to a court order which provides for the protection of sensitive information of interested parties including the department: (1) In actions arising out of the department's designation of a hospital or health care facility pursuant to this section; (2) in actions arising out of the department's revocation or suspension of designation status of a hospital or health care facility under this section; or (3) in actions arising out of the restriction or revocation of the clinical or staff privileges of a health care provider as defined in RCW ((70.70.020)) 7.70.020 (1) and (2), subject to any further restrictions on disclosure in RCW 4.24.250 that may apply. Information that identifies individual patients shall not be publicly disclosed without the patient's consent. When a facility requests designation for more than one service, the department may coordinate the joint consideration of such requests.
     On-site reviews, inspections or surveys of hospitals licensed under chapter 70.41 RCW or health care facilities operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).
     The department may establish fees to help defray the costs of this section, though such fees shall not be assessed to health care facilities authorized to provide level IV and V trauma care services.
     This section shall not restrict the authority of a hospital or a health care provider licensed under Title 18 RCW to provide services which it has been authorized to provide by state law.

Sec. 30   RCW 70.168.080 and 1990 c 269 s 10 are each amended to read as follows:
     (1) Any provider desiring to provide a verified prehospital trauma care service shall indicate on the licensing application how they meet the standards required for verification as a provider of this service. The department shall notify the regional emergency medical services and trauma care councils of the providers of verified trauma care services in their regions. The department may conduct on-site reviews of prehospital providers to assess compliance with the applicable standards. On-site reviews, inspections, or surveys of prehospital providers operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).
     (2) Should the department determine that a prehospital provider is substantially out of compliance with the standards, the department shall notify the regional emergency medical services and trauma care council. If the failure of a prehospital provider to comply with the applicable standards results in the region being out of compliance with its regional plan, the council shall take such steps necessary to assure the region is brought into compliance within a reasonable period of time. The council may seek assistance and funding from the department and others to provide training or grants necessary to bring a prehospital provider into compliance. The council may appeal to the department for modification of the regional plan if it is unable to assure continued compliance with the regional plan. The department may authorize modification of the plan if such modifications meet the requirements of this chapter. The department may suspend or revoke the authorization of a prehospital provider to provide a verified prehospital service if the provider has refused or been unable to comply after a reasonable period of time has elapsed. The council shall be notified promptly of any revocations or suspensions. Any prehospital provider whose verification has been suspended or revoked may request a hearing to review the action by the department as provided for in chapter 34.05 RCW.
     (3) The department may grant a variance from provisions of this section if the department determines: (a) That no detriment to public health and safety will result from the variance, and (b) compliance with provisions of this section will cause a reduction or loss of existing prehospital services. Variances may be granted for a period not to exceed one year. A variance may be renewed by the department. If a renewal is granted, a plan of compliance shall be prepared specifying steps necessary to bring a provider or region into compliance and expected date of compliance.
     (4) This section shall not restrict the authority of a provider licensed under Title 18 RCW to provide services which it has been authorized to provide by state law.

Sec. 31   RCW 71.12.480 and 2000 c 93 s 24 are each amended to read as follows:
     The department of health shall not grant any such license until it has made an examination of all phases of the operation of the establishment necessary to determine compliance with rules adopted under this chapter including the premises proposed to be licensed and is satisfied that the premises are substantially as described, and are otherwise fit and suitable for the purposes for which they are designed to be used, and that such license should be granted. Examinations of establishments operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

Sec. 32   RCW 71.12.485 and 1995 c 369 s 61 are each amended to read as follows:
     Standards for fire protection and the enforcement thereof, with respect to all establishments to be licensed hereunder, shall be the responsibility of the chief of the Washington state patrol, through the director of fire protection, who shall adopt such recognized standards as may be applicable to such establishments for the protection of life against the cause and spread of fire and fire hazards. The department of health, upon receipt of an application for a license, or renewal of a license, shall submit to the chief of the Washington state patrol, through the director of fire protection, in writing, a request for an inspection, giving the applicant's name and the location of the premises to be licensed. Upon receipt of such a request, the chief of the Washington state patrol, through the director of fire protection, or his or her deputy shall make an inspection of the establishment to be licensed, and if it is found that the premises do not comply with the required safety standards and fire ((regulations as promulgated)) rules adopted by the chief of the Washington state patrol, through the director of fire protection, he or she shall promptly make a written report to the establishment and the department of health as to the manner and time allowed in which the premises must qualify for a license and set forth the conditions to be remedied with respect to fire regulations. The department of health, applicant or licensee shall notify the chief of the Washington state patrol, through the director of fire protection, upon completion of any requirements made by him or her, and the director of fire protection or his or her deputy shall make a reinspection of such premises. Whenever the establishment to be licensed meets with the approval of the chief of the Washington state patrol, through the director of fire protection, he or she shall submit to the department of health a written report approving same with respect to fire protection before a full license can be issued. The chief of the Washington state patrol, through the director of fire protection, shall make or cause to be made inspections of such establishments at least annually. The department of health shall not license or continue the license of any establishment unless and until it shall be approved by the chief of the Washington state patrol, through the director of fire protection, as ((herein)) provided in this section.
     In cities which have in force a comprehensive building code, the provisions of which are determined by the chief of the Washington state patrol, through the director of fire protection, to be equal to the minimum standards of the chief of the Washington state patrol, through the director of fire protection, for such establishments, the chief of the fire department, provided the latter is a paid chief of a paid fire department, shall make the inspection with the chief of the Washington state patrol, through the director of fire protection, or his or her deputy, and they shall jointly approve the premises before a full license can be issued. Inspections of establishments operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

Sec. 33   RCW 71.12.500 and 2000 c 93 s 25 are each amended to read as follows:
     The department of health may at any time examine and ascertain how far a licensed establishment is conducted in compliance with this chapter, the rules adopted under this chapter, and the requirements of the license therefor. However, examinations of licensed establishments operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act). If the interests of the patients of the establishment so demand, the department may, for just and reasonable cause, suspend, modify, or revoke any such license. RCW 43.70.115 governs notice of a license denial, revocation, suspension, or modification and provides the right to an adjudicative proceeding.

Sec. 34   RCW 74.09.200 and 1979 ex.s. c 152 s 1 are each amended to read as follows:
     The legislature finds and declares it to be in the public interest and for the protection of the health and welfare of the residents of the state of Washington that a proper regulatory and inspection program be instituted in connection with the providing of medical, dental, and other health services to recipients of public assistance and medically indigent persons. In order to effectively accomplish such purpose and to assure that the recipient of such services receives such services as are paid for by the state of Washington, the acceptance by the recipient of such services, and by practitioners of reimbursement for performing such services, shall authorize the secretary of ((the department of)) social and health services or ((his)) a designee, to inspect and audit all records in connection with the providing of such services. Inspections, audits, and surveys of hospitals licensed under chapter 70.41 RCW and health care services or facilities operated or controlled by hospitals licensed under chapter 70.41 RCW must be coordinated and scheduled in accordance with chapter 43.-- RCW (sections 1 through 5 of this act).

NEW SECTION.  Sec. 35   Section 5 of 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 takes effect immediately.

NEW SECTION.  Sec. 36   Sections 1 through 4 and 7 through 34 of this act take effect January 1, 2004.

NEW SECTION.  Sec. 37   Sections 1 through 5 of this act constitute a new chapter in Title 43 RCW.