WSR 26-08-039
PROPOSED RULES
DEPARTMENT OF HEALTH
[Filed March 25, 2026, 9:27 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 25-20-068.
Title of Rule and Other Identifying Information: Birthing centers; proposing rule language amendments in WAC 246-329-020 and 246-329-055 to incorporate recently passed legislation concerning accredited birthing centers.
The department of health (department) is proposing amendments to its birthing center licensing rules to incorporate recently passed legislation, SHB 1824 (chapter 69, Laws of 2025), concerning accredited birthing centers. Proposed rule amendments also adjust the department's survey interval from 24 months to 36 months and make other updates to increase clarity and consistency of rule language.
Hearing Location(s): On May 5, 2026, at 11:00 a.m. Register in advance for this webinar at https://us02web.zoom.us/webinar/register/WN_lOWp32iDTfuZ1WxisQXTrQ. 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: May 12, 2026.
Submit Written Comments to: John Hilger, P.O. Box 47852, Olympia, WA 98504-7852, email john.hilger@doh.wa.gov, web https://fortress.wa.gov/doh/policyreview, beginning the date and time of filing, by May 5, 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 April 21, 2026.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of the proposed rule is to incorporate recently passed legislation (SHB 1824) into the birthing center licensing rules. The proposed amendments:
| |
| • | Exempt qualifying accredited birthing centers from most department surveys under SHB 1824, the time frame for validation surveys; and |
| • | Make other updates as appropriate to increase clarity and consistency of rule language. |
Reasons Supporting Proposal: The proposed rule incorporates SHB 1824 requirements into the birthing center licensing rules as directed by the 2025 legislature.
Incorporating SHB 1824 requirements into rule will ensure birthing centers have clear guidance on how to communicate their accreditation status to the department and qualify for an exemption to state surveys. Adjusting the department's survey interval from 24 months to 36 months will ensure all birthing centers are subject to the same survey schedule and reduce regulatory burden associated with tracking survey intervals and participating in surveys.
Statute Being Implemented: SHB 1824, codified as RCW
18.46.080.
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 and Implementation: John Hilger, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-2929; Enforcement: Julie Tomaro, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-2950.
A school district fiscal impact statement is not required under RCW
28A.305.135.
A cost-benefit analysis is required under RCW
34.05.328. A preliminary cost-benefit analysis may be obtained by contacting John Hilger, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-2929, TTY 711, email
john.hilger@doh.wa.gov.
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 are adopting or incorporating by reference without material change federal statutes or regulations, Washington state statutes, rules of other Washington state agencies, shoreline master programs other than those programs governing shorelines of statewide significance, or, as referenced by Washington state law, national consensus codes that generally establish industry standards, if the material adopted or incorporated regulates the same subject matter and conduct as the adopting or incorporating rule; and rules only correct typographical errors, make address or name changes, or clarify language of a rule without changing its effect.
Explanation of exemptions: Some portions of the proposed rules are exempt from analysis because they renumber and clarify subsection language. Other portions of the proposed rules are exempt because they incorporate statutory language by reference.
Scope of exemption for rule proposal:
Is partially exempt:
Explanation of partial exemptions: [See below.]
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated.
A brief description of the proposed rule, including the current situation/rule, followed by the history of the issue and why the proposed rule is needed. A description of the probable compliance requirements and the kinds of professional services that a small business is likely to need in order to comply with the proposed rule: The department licenses birthing centers with the intent to establish and promote safe birthing care at these facilities. The licensing requirements include routine surveys by the department. The department is proposing amendments to its birthing center licensing rules in chapter 246-329 WAC to incorporate recent legislation and improve regulatory clarity and consistency.
SHB 1824 was passed by the legislature in 2025. This bill amends the birthing center statute (chapter
18.46 RCW) to exempt birthing centers accredited by a birthing center accrediting body from routine department surveys when:
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| • | The department determines that the accrediting body's standards are substantially equivalent to the department's; |
| • | An accreditation survey was completed in the past 36 months; |
| • | The department receives copies of the latest survey report; and |
| • | Those reports indicate compliance with licensure requirements. |
The proposed rule amendments cite and align with this new statutory language.
Additionally, the proposed rules make amendments to reduce administrative burden, provide clarification, and update style. These amendments include:
| |
| • | Adjusting the survey frequency for all birthing centers from 24 to 36 months. This aligns all birthing centers, both accredited and nonaccredited, with a 36-month survey schedule; |
| • | Clarifying that a maximum of 10 percent of accredited birthing centers may be subject to a validation survey over a 36-month period; and |
| • | Updating rules to use active voice, clear language, and consistent terminology. |
In order to implement SHB 1824, the department determined that the birthing center licensing rules needed to be opened so that staff could formally collaborate with birthing center owners on appropriately incorporating bill requirements into rule. The department filed a CR-101 under WSR 25-20-068 on September 29, 2025, to announce the opening of the rules.
The department scheduled three public rules workshops between October and November 2025, and broadly communicated these dates through various GovDelivery subscription lists, as well as targeted emails. The workshops were open to the public but the majority of participants were midwives who own birthing centers. The department currently licenses 25 birthing centers. Representatives from 15 birthing centers participated in all three rules workshops, which equals 60 percent of licensees.
During the rule workshops, cost of compliance was regularly discussed when considering how to incorporate SHB 1824 requirements into rule. Midwives indicated that 15 of the 25 licensed birthing centers are currently accredited by the Commission for the Accreditation of Birth Centers and provided detailed accreditation costs. Midwives also provided time and cost estimates for periodically sending to the department accreditation survey reports.
The proposed rules reduce compliance requirements for birthing centers, including:
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| • | Aligning with SHB 1824, which exempts accredited birthing centers from routine department surveys, while still allowing initial licensure surveys and limited validation surveys; and |
| • | Reducing the frequency of routine department surveys for nonaccredited birthing centers from once every 24 months to once every 36 months. |
Additional proposed rule amendments are focused on clarifying language of the rule.
Identification and summary of which businesses are required to comply with the proposed rule using the North American Industry Classification System (NAICS):
Table 1. Summary of Businesses Required to Comply to the Proposed Rule:
| NAICS Code (4, 5, or 6 digit) | NAICS Business Description | Number of Businesses in Washington State | Minor Cost Threshold | |
| 621399 | Offices of All Other Miscellaneous Health Practitioners (including offices/clinics of midwives) | 5,023 (2021 Dataset pulled from the department of revenue (DOR)) | $927.25 (2021 Dataset pulled from DOR) | |
Analysis of probable costs of businesses in the industry to comply to the proposed rule and includes the cost of equipment, supplies, labor, professional services, and administrative costs. The analysis considers if compliance with the proposed rule will cause businesses in the industry to lose sales or revenue:
WAC 246-329-020 Licensure.
Description: WAC 246-329-020 outlines the requirements for obtaining and maintaining a birthing center license. Subsection (2) outlines the renewal requirements, and in subsection (2)(b), it provides that the department may survey each birthing center every 24 months or as needed to ensure compliance with the licensing rules and statute.
The proposed rule changes the survey frequency from 24 to 36 months.
SHB 1824 specifically exempts accredited birthing centers from department surveys if they provide the department with documentation of survey by the accrediting body within the past 36 months. The department licenses and surveys a wide range of health care facilities and agencies, with survey intervals ranging from 12 to 36 months. Historically, the department chose a 24-month survey interval for birthing centers. To align with the 36-month schedule for accredited birthing centers, the department is proposing to adjust the survey frequency for nonaccredited birthing centers to 36 months.
Throughout the proposed rule, the following amendments have been made and are exempt from analysis under RCW
34.05.328 (5)(b)(iv), as they clarify language of a rule without changing its effect:
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| • | Using plain language alternatives to current text; |
| • | Replacing nonstandard terms with the term "birthing center"; |
| • | Replacing "must" with "shall" when appropriate; |
| • | Consistently citing WAC 246-329-990 when fees are referenced; |
| • | Updating formatting to conform to current standards; and |
| • | Rewording passive sentences into active voice. |
Cost(s): The department does not anticipate any additional costs to birthing centers by extending the survey schedule from 24 to 36 months because the proposed rule is extending the time period between surveys. Extending the survey schedule from 24 to 36 months is anticipated to result in a cost savings of $173 per year for nonaccredited birthing centers.
Typically, a department survey involves the following:
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| • | Approximately eight hours estimated for the survey, which requires the midwife/owner's time. At $65 per hour, this is approximately $520; |
| • | The department issuing the birthing center a statement of deficiency for at least some areas of noncompliance with the rules; and |
| • | The birthing center writing and submitting a plan of correction for department approval. This may require approximately eight hours estimated of the midwife/owner's time at $65 per hour, or approximately $520. |
Based on these estimates for a typical birthing center survey, current costs for a survey are estimated at $1,040 in midwife/owner time.
When typical survey costs are distributed over the current 24-month survey cycle, the cost is approximately ($1,040 per year/two years) $520 per year in midwife/owner time.
When typical survey costs are distributed over a 36-month survey cycle, the cost is approximately ($1,040 per year/three years) $347 per year in midwife/owner time.
As a result, switching from a 24-month survey cycle to a 36-month survey cycle is likely to result in cost savings of $173 per year (difference between two years and three years) for a nonaccredited birthing center.
While the proposed amendment impacts the default survey schedule for all birthing centers, SHB 1824 exempts qualifying accredited birthing centers from routine department surveys. In practice, this change will mainly impact nonaccredited birthing centers.
WAC 246-329-055 Department responsibilities.
Description: WAC 246-329-055 documents in rule the department's responsibilities and authority in regulating birthing centers, including issuing and renewing licenses; conducting surveys; investigating persons and licensees suspected of violating applicable laws or regulations; issuing a statement of deficiencies; revoking licenses; and more.
This rule contains the following significant amendments:
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| • | Subsection (2)(a) changes the department's survey frequency for birthing centers from 24 months to 36 months. This amendment aligns with changes described and analyzed under WAC 246-329-020 amendments above. |
| • | Statutory language limits department validation surveys to 10 percent of accredited birthing centers. The time period this applies to, however, is ambiguous. Subsection (3)(b) adds that the 10 percent limit applies to a period of 36 months. |
The following proposed amendments are exempt from analysis:
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| • | Subsections (2)(b)(i) and (ii) were renumbered for clarity as (2)(b) and (c). This is exempt under RCW 34.05.328 (5)(b)(iv), as the amendments clarify language of a rule without changing its effect. |
| • | Subsection (3)(c) establishes that the exemptions available for accredited birthing centers do not apply to the department's initial licensing process or enforcement authority. This is exempt under RCW 34.05.328 (5)(b)(iii), as the amendments adopt without material change Washington state statutes. |
| • | Throughout the rule, the following amendments are exempt from analysis under RCW 34.05.328 (5)(b)(iv), as they clarify language of a rule without changing its effect: |
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| o | Consistently citing WAC 246-329-990 when fees are referenced; and |
| o | Updating formatting to conform to current standards. |
Cost(s): For accredited birthing centers, the proposed rule aligns the statutory 10 percent limit on validation surveys with the statutory 36-month survey cycle, with no additional cost anticipated.
Currently, the department surveys all birthing centers (accredited and nonaccredited), so accredited birthing centers are bearing the costs of two surveys, one from the accrediting body and one from the department. SHB 1824 provides that accredited birthing centers are exempt from the department surveys. The department does not anticipate that aligning the statutory 10 percent limit on validation surveys with the 36-month survey cycle will increase any facility's likelihood of being subject to a survey.
Summary of all cost(s) and benefit(s):
| WAC Section and Title | Probable Cost(s) | |
| WAC 246-329-020 Licensure | Savings of approximately $173 per year | |
| WAC 246-329-055 Department responsibilities | No additional costs anticipated | |
Analysis on if the proposed rule may impose more-than-minor costs for businesses in the industry. Includes a summary of how the costs were calculated: No, the annual cost impact of the proposed rule (a net savings of approximately $173 per year) is less than the minor cost threshold ($927.25).
Summary of how costs were calculated: The department calculated costs after seeking input from midwives/owners during rule workshops. Based on information provided by midwives/owners, a department survey typically has the following impacts on a birthing center:
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| • | Approximately eight hours for the survey, which requires the midwife/owner's time. At $65 per hour, this is approximately $520; and |
| • | The midwife/owner of a birthing center must write and submit follow-up documentation to the department, including a plan of correction addressing any deficiencies or noncompliance with department standards. This may require approximately eight hours of the midwife/owner's time at $65 per hour, or approximately $520. |
Based on a midwife/owner's typical hourly wage of $65 per hour, a survey results in approximately 16 hours of time for a midwife/owner, or approximately $1,040 per survey.
This estimated $1,040 cost per survey is the key figure used to calculate the impact of the department's significant rule amendments.
Extending Survey Cycle from 24 to 36 Months: A typical survey costs a birthing center an estimated $1,040.
Currently, the department's routine inspection schedule for birthing centers involves conducting one survey every 24 months. When typical survey costs, $1,040, are distributed over the current 24-month inspection cycle, the cost is approximately $520 per year ($1,040/two years).
The proposed rules would shift to an inspection schedule that involves conducting one survey every 36 months. When estimated survey costs, $1,040, are distributed over the proposed 36-month inspection cycle, the cost is approximately $347 per year ($1,040/three years).
The annual cost difference between the current schedule ($520) and the proposed schedule ($347) is $173. As a result, switching from a 24-month inspection cycle to a 36-month inspection cycle is likely to result in cost savings of $173 per year for a nonaccredited birthing center.
Validation Survey Limits Subject to a 36-Month Time Frame: Currently, the department surveys all birthing centers (accredited and nonaccredited), and accredited birthing centers are bearing the costs of two surveys, one from the accrediting body and one from the department.
Under SHB 1824, qualifying accredited birthing centers are exempt from routine department surveys. The statute also gives the department authority to conduct "validation surveys" to confirm accrediting body standards match department standards. Under the statute, the department can perform validation surveys on up to 10 percent of accredited birthing centers. To clarify this provision, the department proposes adding that this 10 percent limit applies to a 36-month time frame. The department does not anticipate that aligning the statutory 10 percent limit on validation surveys with the 36-month survey cycle will increase any facility's likelihood of being subject to a survey. Therefore, this change is not anticipated to create any additional costs.
The public may obtain a copy of the small business economic impact statement or the detailed cost calculations by contacting John Hilger, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-2929, TTY 711, email john.hilger@doh.wa.gov.
March 25, 2026
Kristin Peterson, JD
Chief of Policy
for Dennis E. Worsham
Secretary of Health
RDS-6884.3
AMENDATORY SECTION(Amending WSR 25-15-078, filed 7/15/25, effective 8/15/25)
WAC 246-329-020Licensure.
A person must ((
possess))
have a current ((
birth))
birthing center license issued by the department before advertising, operating, managing, conducting, opening or maintaining a birthing center unless exempt under chapter
18.46 RCW. A ((
birth))
birthing center applicant working towards licensure may begin advertising via website or other means provided that language clearly communicates that the center is not currently licensed.
(1) Application for license. An applicant for initial licensure of a birthing center ((must))shall:
(a) Submit a completed application on forms provided by the department;
(b) Submit disclosure statements and criminal history background checks no older than three months preceding the application date for the administrator, owner and director of services in accordance with RCW
43.43.830 through
43.43.845;
(c) Submit the following information:
(i) Name of managing personnel, officers, administrator, director of services, and partners or individuals owning 10 percent or more of the applicant's voting stock;
(ii) A description of the organizational structure;
(iii) A copy of the current business license(s);
(d) Submit evidence of completion of the department's construction review process;
(e) Submit evidence of compliance with local codes and ordinances;
(f) Submit evidence of approval of the state fire marshal as required per RCW
18.46.110;
(g) Submit evidence that a certificate of occupancy by the local building official has been approved and issued;
(h) Submit other information as required by the department;
(i) Submit fees ((as specified in))under WAC 246-329-990;
(j) Develop and approve policies and procedures addressing the content of this chapter; and
(k) Meet the requirements of this chapter as determined by an initial survey conducted by the department.
(2) License renewal. (((a))) A license, unless suspended or revoked, must be renewed annually.
(a) A licensee shall submit an application((
s)) for renewal ((
must be)) on forms provided by the department ((
and must be filed with the department not less than))
at least 30 days prior to expiration ((
and))
. The application must also include disclosure statements and criminal history background checks no older than three months preceding the renewal date for the administrator, owner, and director of services when these individuals are new to the ((
birth))
birthing center since initial licensure or last renewal, in accordance with RCW
43.43.830 through
43.43.845.
(b) The department may inspect and investigate each birthing center every ((
24))
36 months or as needed to determine compliance with these rules and chapter
18.46 RCW.
(c) ((Each))The department shall issue a license ((must be issued)) only for the premises and persons named. ((Licenses must be transferable or assignable only with written approval by the department.))The department must provide written approval before a license may be transferred or assigned to another administrator, owner, or director of services.
(d) ((Licenses must be posted))The birthing center must post the current license in a conspicuous place on the licensed premises.
(3) Change of ownership. At least 30 days prior to changing ownership of a birthing center:
(a) The licensee ((must))shall submit in writing to the department:
(i) The full name, address and phone number of the current and prospective owner;
(ii) The name, address, and phone number of the currently licensed birthing center and the name under which the prospective agency will operate; and
(iii) Date of the proposed change of ownership;
(b) The prospective new owner ((must))shall submit:
(i) Information listed in subsection (1)(b) and (c) of this section; and
(ii) The change of ownership fee ((specified in))under WAC 246-329-990.
(4) The department may conduct a survey after a change of ownership approval to assess the new ownership's delivery of care to patients. The decision to conduct a survey ((would be))is based on department surveys, complaint investigations, and enforcement actions associated with the new owner(s).
AMENDATORY SECTION(Amending WSR 25-15-078, filed 7/15/25, effective 8/15/25)
WAC 246-329-055Department responsibilities.
This section describes the department's responsibilities in the fulfillment of the requirements of this chapter:
(1) The department may, in accordance with chapter
18.46 RCW:
(a) Issue an initial license for 12 months following submission of a completed application and appropriate fees under WAC 246-329-990, and following a survey that documents the applicant meets all the requirements of this chapter;
(b) Issue a renewal license for the 12-month period following submission of a completed application and appropriate fees under WAC 246-329-990;
(c) Issue a license for change of ownership to the new licensee for the remainder of the current license period following submission of the required information and appropriate fee, under WAC 246-329-990.
(2) The department may:
(a) Conduct surveys and investigations every ((
24))
36 months or as needed to determine compliance with chapter
18.46 RCW and this chapter. Surveys and investigations may be announced or unannounced;
(b) Investigate any person suspected of((:
(i)))
advertising, operating, managing, conducting, opening or maintaining a birthing center without a license unless exempt from licensure under chapter
18.46 RCW; or
(((ii)))(c) Survey a licensee at anytime if the department has reason to believe the licensee is providing unsafe, insufficient, inadequate or inappropriate care;
((
(c)))
(d) Investigate allegations of noncompliance with RCW
43.43.830 through
43.43.845, when necessary, in consultation with law enforcement personnel;
((
(d)))
(e) Require licensees to complete additional disclosure statements and background inquiries for an individual associated with the licensee or having direct contact with children under 16 years of age, people with developmental disabilities, or vulnerable adults if the department has reason to believe that offenses specified under RCW
43.43.830 have occurred since completion of the previous disclosure statement and criminal background inquiry; and
((
(e)))
(f) Issue a statement of deficiencies following a survey which identifies noncompliance with chapter
18.46 RCW and this chapter.
(a) A birthing center that is accredited by a birthing center accrediting body is not subject to a state licensure survey in subsection (2)(a) of this section.
(b) The department may perform validation surveys. Validation surveys may not exceed 10 percent of accredited birthing centers within a 36-month time frame.
(c) This does not affect the department's initial licensing process or enforcement authority for licensed birthing centers.
(4) The department may deny, suspend, or revoke a license if the applicant or licensee fails or refuses to comply with the requirements of chapter
18.46 RCW and these rules. The department's notice of denial, suspension, modification, or revocation of a license must be consistent with RCW
43.70.115. An applicant or license holder has the right to an adjudicative proceeding to contest the decision.
((
(4)))
(5) The department may prepare and serve upon the licensee or applicant at the earliest practical time a statement of charges following a survey which identifies noncompliance with chapter
18.46 RCW and this chapter. The statement of charges must include a notice that the licensee or applicant may request a hearing to contest the charges.