DEPARTMENT OF HEALTH

[Filed December 1, 2025, 3:01 p.m.]

Preproposal statement of inquiry was filed as WSR 25-16-077.

Title of Rule and Other Identifying Information: Birthing center fees. The department of health (department) is proposing rule amendments to update the existing fees and adding a fee and fee structure to include accreditation status for birthing centers in WAC 246-329-990.

Hearing Location(s): On January 6, 2026, at 2:00 p.m. Register in advance for this webinar at https://us02web.zoom.us/webinar/register/WN_x-pSSGDeTqaqxIYgK240wA. After registering, you will receive a confirmation email containing information about joining the webinar. The department will be offering a virtual webinar hearing only. Individuals may attend virtually or submit comments in writing.

Date of Intended Adoption: January 9, 2026.

Submit Written Comments to: John Hilger, P.O. Box 47850, Olympia, WA 98504-7850, email HSQAFeeRules@doh.wa.gov, web https://fortress.wa.gov/doh/policyreview/, beginning the date and time of filing, by January 6, 2026, at 11:59 p.m.

Assistance for Persons with Disabilities: Contact John Hilger, phone 360-236-2929, TTY 711, email john.hilger@doh.wa.gov, web doh.wa.gov, by December 30, 2025.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The department is proposing amendments to WAC 246-329-990 to increase birthing center fees for initial license, renewal, and other charges. Rule making is necessary to comply with RCW 43.70.250, update current rule language, and create an enforceable fee schedule. These changes also include an accreditation category for fees.

Reasons Supporting Proposal: RCW 43.70.250 requires that licensure fees fully fund the work of licensing and regulating health care facilities. Current birthing center revenue is insufficient to cover operating costs for the birthing center regulatory program (program). The program ended fiscal year (FY) 2024 with a revenue shortfall of $85,000. The department anticipates the current funding gap to widen as costs continue to increase in upcoming years, leading to a projected annual shortfall of $105,000 by FY 2030. To ensure the program's financial sufficiency and sustainability, and maintain compliance with state statutory requirements, a fee increase is necessary.

Statutory Authority for Adoption: RCW 18.46.030, 43.70.110, and 43.70.250.

Statute Being Implemented: RCW 43.70.250.

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, Implementation, and Enforcement: John Hilger, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-2929.

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. This rule is exempt from analysis according to RCW 34.05.328 (5)(b)(vi) because it is a rule that sets or adjusts fees 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.

Explanation of exemptions: The proposed rules set and adjust fees for birthing centers under RCW 34.05.310 (4)(f).

Scope of exemption for rule proposal:

Kristin Peterson, JD

for Dennis E. Worsham

AMENDATORY SECTION(Amending WSR 25-15-078, filed 7/15/25, effective 8/15/25)

WAC 246-329-990Fees.

The purpose of the fees section is to describe the fees associated with licensing, renewal, and other charges assessed by the department.

(1) A birthing center recognized as a charitable, nonprofit, or government-operated institution is exempt from fees under RCW 18.46.030.

(2) A birthing center shall submit a $3,000 application fee to the department.

(3) A birthing center((s)) licensed under chapter 18.46 RCW ((must))shall submit to the department an annual renewal fee of (($713 to the department unless a center is a charitable, nonprofit, or government-operated institution under RCW 18.46.030.

(2)))either:

(a) $3,000 for a birthing center; or

(b) $1,800 for an accredited birthing center under RCW 18.46.080.

(4) A change of ownership fee of (($178))$1,000. A new license will be issued and valid for the remainder of the current license period.

(((3)))(5) The department may charge and collect from a licensee a fee of (($892))$3,000 for:

(a) An on-site follow-up compliance survey deemed necessary in order to complete the standard survey process;

(b) An on-site compliance survey deemed necessary due to failure of the licensee to adequately respond to a statement of deficiencies; or

(((4)))(6) A licensee ((must))shall submit an additional late fee in the amount of (($29))$50 per day, not to exceed (($595))$1,000, from the renewal date (which is 30 days before the current license expiration date) until the date of mailing the fee, as evidenced by the postmark, or electronic submission.

(((5)))(7) Refunds. The department ((must))shall refund fees paid by the applicant for initial licensure as follows:

(a) If an application has been received but no on-site survey or technical assistance has been performed by the department, two-thirds of the fees paid, less a $50 processing fee; or

(b) If an application has been received and an on-site survey or technical assistance has been performed by the department, one-third of the fees paid, less a $50 processing fee.

(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, but no license is issued because applicant failed to complete requirements for licensure; or

(iii) The amount to be refunded as calculated by (a) or (b) of this subsection is $10 or less.