WSR 19-11-117
PROPOSED RULES
DEPARTMENT OF HEALTH
[Filed May 22, 2019, 7:36 a.m.]
Original Notice.
Title of Rule and Other Identifying Information: WAC 246-320-199, 246-322-990 and 246-324-990, hospital fees, the department of health is proposing increased initial license and annual fees for acute care, psychiatric, and alcohol and chemical dependency hospitals.
Hearing Location(s): On June 25, 2019, at 10:00, at the Department of Health, Point Plaza East Room 152-153, 310 Israel Road, Tumwater, WA 98501.
Date of Intended Adoption: July 2, 2019.
Submit Written Comments to: Stephanie Vaughn, Policy Analyst, P.O. Box 47850, Olympia, WA 98504-7850, email https://fortress.wa.gov/doh/policyreview, fax 360-236-2901, by June 25, 2019.
Assistance for Persons with Disabilities: Contact Stephanie Vaughn, phone 360-236-4617, fax 360-236-2901, TTY 360-833-6388 or 711, email stephanie.vaughn@doh.wa.gov, by June 18, 2019.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The department is proposing amendments to sections of WAC regarding hospital fees to increase initial license and annual fees for acute care, psychiatric, and alcohol and chemical dependency hospitals to address a funding gap. The funding gap must be addressed to fund the department's inspection and investigation work to protect patients. Additional revenue is needed to meet the requirement in RCW
43.70.250 stating that fees must cover regulatory program expenses. A fee increase is necessary to adequately fund the hospital inspection, investigation, and licensing programs.
Reasons Supporting Proposal: Current revenue from hospital licensing fees does not support all mandated regulatory activities, such as ongoing inspections and investigations of all one hundred seven licensed hospitals. Only about sixty-six percent of the funding needed to support the regulation of hospitals is generated by licensing fees. The department anticipates an average annual funding gap of about $1 million based on current hospital fee revenue and projected expenditures necessary to conduct the work required by law. There are a few factors that have led to this funding gap: Changes made by the Centers for Medicare and Medicaid Services (CMS) that reduce our ability to do dual purpose investigations (state and CMS) and split the cost with the federal government; and staff salary increases over the last several years.
In addition to not covering current expenses, the current revenue level provides no reserves for unexpected program costs. The office of financial management recommends a reserve level of two months of expenditures, equivalent to seventeen percent of annual expenditures. The hospital licensing program will not be able to build the reserve as long as expenditures continue to exceed revenue.
Fees were last raised for hospitals in 2017, but the increase only addressed the revenue need for fire code inspections. This fee increase did not impact the current gap in funding for regulatory activities conducted by the department. The last time fees were raised to support regulatory program activities was in 2007 for psychiatric and chemical dependency hospitals and 2012 for acute care hospitals. RCW
43.70.250 requires the program to be self-funding and according to agency policy this is to occur within a six year period. A fee increase will be necessary to correct this trend.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of health, governmental.
Name of Agency Personnel Responsible for Drafting: Stephanie Vaughn, 111 Israel Road S.E., Tumwater, WA 98501, 360-246-4617; Implementation and Enforcement: Julie Tomaro, 111 Israel Road S.E., Tumwater, WA 98501, 360-246-2937.
A school district fiscal impact statement is not required under RCW
28A.305.135.
A cost-benefit analysis is not required under RCW
34.05.328. The agency did not complete a cost-benefit analysis under RCW
34.05.328. RCW
34.05.328 (5)(b)(vi) exempts rules that set or adjust fees or rates pursuant to legislative standards.
This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:
Is exempt under RCW
19.85.025(3) as the rules set or adjust fees under the authority of RCW
19.02.075 or that set or adjust fees or rates pursuant to legislative standards, including fees set or adjusted under the authority of RCW
19.80.045.
May 19, 2019
John Wiesman, DrPH, MPH
Secretary
AMENDATORY SECTION(Amending WSR 17-18-109, filed 9/6/17, effective 11/30/17)
WAC 246-320-199Fees.
This section establishes the initial licensure and annual fees for hospitals licensed under chapter
70.41 RCW. The license must be renewed every three years.
(1) Applicants and licensees shall submit to the department:
(a) An initial license fee of ((one hundred thirty-eight))two hundred twenty dollars for each bed space within the authorized bed capacity for the hospital;
(b) An annual fee of ((one hundred thirty-eight))two hundred twenty dollars for each bed space within the authorized bed capacity of the hospital by November 30th of the year.
(2) As used in this section, a bed space:
(a) Includes all bed spaces in rooms complying with physical plant and movable equipment requirements of this chapter for twenty-four-hour assigned patient care;
(b) Includes level 2 and 3 bassinet spaces;
(c) Includes bed spaces assigned for less than twenty-four-hour patient use as part of the licensed bed capacity when:
(i) Physical plant requirements of this chapter are met without movable equipment; and
(ii) The hospital currently possesses the required movable equipment and certifies this fact to the department.
(d) Excludes all normal infant bassinets;
(e) Excludes beds banked as authorized by certificate of need under chapter
70.38 RCW.
(3) A licensee shall submit to the department a late fee in the amount of one hundred dollars per day whenever the annual use fee is not paid by November 30. The total late fee will not exceed twelve hundred dollars.
(4) An applicant may request a refund for initial licensure as follows:
(a) Two-thirds of the initial fee paid after the department has received an application and not conducted an on-site survey or provided technical assistance; or
(b) One-third of the initial fee paid after the department has received an application and conducted either an on-site survey or provided technical assistance but not issued a license.
AMENDATORY SECTION(Amending WSR 17-18-109, filed 9/6/17, effective 11/30/17)
WAC 246-322-990Private psychiatric hospital fees.
This section establishes the initial licensure and annual fees for private psychiatric hospitals licensed under chapter
71.12 RCW.
(1) Applicants and licensees shall:
(a) Submit to the department an initial licensure fee of ((eighty-five))one hundred thirty-five dollars for each bed space within the licensed bed capacity of the hospital to the department;
(b) Submit to the department an annual fee of ((eighty-five))one hundred thirty-five dollars for each bed space within the licensed bed capacity of the hospital to the department;
(c) Include all bed spaces and rooms complying with physical plant and movable equipment requirements of this chapter for twenty-four-hour assigned patient rooms;
(d) Include bed spaces assigned for less than twenty-four-hour patient use as part of the licensed bed capacity when:
(i) Physical plant requirements of this chapter are met without movable equipment; and
(ii) The private psychiatric hospital currently possesses the required movable equipment and certifies this fact to the department((;)).
(e) Limit licensed bed spaces as required under chapter
70.38 RCW;
(f) Submit applications for bed additions to the department for review and approval under chapter
70.38 RCW subsequent to department establishment of the private psychiatric hospital's licensed bed capacity;
(g) Set up twenty-four-hour assigned patient beds only within the licensed bed capacity approved by the department.
(2) Refunds. The department shall refund fees paid by the applicant for initial licensure if:
(a) The department has received the application but has not conducted an on-site survey or provided technical assistance, the department will refund two-thirds of the fees paid, less a fifty dollar processing fee.
(b) The department has received the application and has conducted an on-site survey or provided technical assistance, the department will refund one-third of the fees paid, less a fifty dollar processing fee.
(c) The department will not refund fees if:
(i) The department has performed more than one on-site visit for any purpose;
(ii) One year has elapsed since an initial licensure application is received by the department, and the department has not issued the license because the applicant has failed to complete requirements for licensure; or
(iii) The amount to be refunded as calculated by (a) or (b) of this subsection is ten dollars or less.
AMENDATORY SECTION(Amending WSR 17-18-109, filed 9/6/17, effective 11/30/17)
WAC 246-324-990Fees.
This section establishes the initial licensure and annual fees for private alcohol and chemical dependency hospitals licensed under chapter
71.12 RCW.
(1) Applicants and licensees shall submit to the department:
(a) An initial licensure fee of ((eighty-five))one hundred thirty-five dollars for each bed space within the proposed licensed bed capacity; and
(b) An annual fee of ((eighty-five))one hundred thirty-five dollars for each licensed bed space.
(2) Refunds. The department shall refund fees paid by the applicant for initial licensure if:
(a) The department has received an application but has not conducted an on-site survey or provided technical assistance, the department will refund two-thirds of the fees paid, less a fifty dollar processing fee.
(b) The department has received an application and has conducted an on-site survey or provided technical assistance, the department will refund one-third of the fees paid, less a fifty dollar processing fee.
(c) The department will not refund fees if:
(i) The department has conducted more than one on-site visit for any purpose;
(ii) One year has elapsed since an initial licensure application is received by the department, and the department has not issued the license because applicant has failed to complete requirements for licensure; or
(iii) The amount to be refunded as calculated by (a) or (b) of this subsection is ten dollars or less.