CERTIFICATION OF ENROLLMENT
SUBSTITUTE HOUSE BILL 2295
Chapter 259, Laws of 2024
(partial veto)
68th Legislature
2024 Regular Session
HOSPITAL AT-HOME SERVICES
EFFECTIVE DATE: June 6, 2024
Passed by the House March 4, 2024 CERTIFICATE
Yeas 97 Nays 0
I, Bernard Dean, Chief Clerk of the
House of Representatives of the
LAURIE JINKINS State of Washington, do hereby
Speaker of the House of certify that the attached is
Representatives SUBSTITUTE HOUSE BILL 2295 as
passed by the House of
Representatives and the Senate on
the dates hereon set forth.
Passed by the Senate February 22,
2024
Yeas 49 Nays 0 BERNARD DEAN
Chief Clerk
DENNY HECK
President of the Senate
Approved March 26, 2024 9:20 AM with FILED
the exception of section 6, which is
vetoed. March 27, 2024
Secretary of State
JAY INSLEE State of Washington
Governor of the State of Washington
 SUBSTITUTE HOUSE BILL 2295
AS AMENDED BY THE SENATE
Passed Legislature - 2024 Regular Session
State of Washington 68th Legislature 2024 Regular Session
By House Health Care & Wellness (originally sponsored by
Representatives Bateman, Hutchins, Riccelli, Bronoske, Reed, Orwall,
Davis, Tharinger, Simmons, Callan, and Macri)
READ FIRST TIME 01/31/24.
1 AN ACT Relating to establishing a regulatory structure for
2 licensed acute care hospitals to provide hospital at-home services;
3 amending RCW 70.127.040 and 70.38.111; adding a new section to
4 chapter 70.41 RCW; adding a new section to chapter 70.126 RCW;
5 creating a new section; and declaring an emergency.
6 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
7 NEW SECTION. Sec. 1. (1) The legislature finds that:
8 (a) "Hospital at home" is a service that provides safe and
9 effective care, improves outcomes, and benefits patients. It was
10 developed by Johns Hopkins healthcare solutions and has been used by
11 the veteran's health administration and medical centers in the United
12 States and around the world;
13 (b) Washington hospitals began offering this service following
14 the launch of the centers for medicare and medicaid services acute
15 hospital care at-home program in response to the COVID-19 pandemic.
16 Since that time, participating Washington patients have experienced
17 fewer readmissions and shorter treatment periods and report high
18 rates of satisfaction;
19 (c) Authorizing the continuation of this service would benefit
20 patients in Washington, a state with one of the lowest number of beds
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1 per patient population in the country and a track record of providing
2 high quality inpatient care; and
3 (d) Immediate authorization of this service is necessary to
4 preserve continuity of care and provision of services without
5 disruption.
6 (2) It is the intent of the legislature to authorize acute care
7 hospitals licensed under this chapter to continue providing hospital
8 at-home services and direct the department to adopt rules including
9 those services among those that may be offered by such hospitals.
10 NEW SECTION. Sec. 2. A new section is added to chapter 70.41
11 RCW to read as follows:
12 (1) Hospitals subject to this chapter may provide hospital at-
13 home services if they have an active federal program waiver prior to
14 when the department adopts rules pursuant to this section. Hospitals
15 that have an active federal program waiver and intend to operate
16 hospital at-home services within Washington state shall notify the
17 department within 30 days of receiving the waiver.
18 (2)(a) The department shall adopt rules by December 31, 2025, to
19 implement this act and add hospital at-home services to those
20 services that may be provided by an acute care hospital licensed
21 under this chapter. The rules shall establish standards for the
22 operation of a hospital at-home program. In establishing the initial
23 standards, the department shall consider the provisions of the
24 federal program and endeavor to make the standards substantially
25 similar. The standards may not include requirements that would make a
26 hospital ineligible for or preclude a hospital from complying with
27 the requirements of the federal program. The department may adopt
28 additional standards to promote safe care and treatment of patients
29 as needed.
30 (b) In the event that the federal program expires before the
31 department establishes rules, hospitals shall continue to follow
32 federal program requirements that were in effect as of the date of
33 the federal program's expiration and the department shall enforce
34 such requirements until the department adopts rules.
35 (c) Once rules are established, hospitals that intend to offer or
36 continue offering hospital at-home services shall apply to the
37 department for approval to add hospital at-home services as a
38 hospital service line. Hospitals that have secured a federal program
39 waiver prior to rule adoption may provide hospital at-home services
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 1 while applying for approval. The department shall approve a hospital
2 to provide hospital at-home services if the application is consistent
3 with the standards established in rule. RCW 43.70.115 and chapter
4 34.05 RCW govern notice and adjudicative proceedings related to
5 denial of an application. The department may set a one-time
6 application fee in rule. The application fees charged shall not
7 exceed the actual cost of staff time to review. The administration of
8 the program must be covered by licensing fees set by the department
9 under the authority of RCW 70.41.100 and 43.70.250.
10 (3) Hospital at-home services are not subject to chapter 70.126
11 or 70.127 RCW.
12 (4) Hospital at-home services do not count as an increase in the
13 number of the hospital's licensed beds and are not subject to chapter
14 70.38 RCW.
15 (5) The definitions in this subsection apply throughout this
16 section unless the context clearly requires otherwise.
17 (a) "Hospital at-home services" means acute care services
18 provided by a licensed acute care hospital to a patient outside of
19 the hospital's licensed facility and within a home or any location
20 determined by the patient receiving the service.
21 (b) "Federal program" means the acute hospital care at-home
22 program established by the federal centers for medicare and medicaid
23 services under 42 U.S.C. Sec. 1320b-5 and extended by 42 U.S.C Sec.
24 1395cc-7, or any successor program.
25 NEW SECTION. Sec. 3. A new section is added to chapter 70.126
26 RCW to read as follows:
27 This chapter does not apply to hospital at-home services provided
28 by an acute care hospital licensed under chapter 70.41 RCW.
29 Sec. 4. RCW 70.127.040 and 2020 c 258 s 2 are each amended to
30 read as follows:
31 The following are not subject to regulation for the purposes of
32 this chapter:
33 (1) A family member providing home health, hospice, or home care
34 services;
35 (2) A person who provides only meal services in an individual's
36 permanent or temporary residence;
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 1 (3) An individual providing home care through a direct agreement
2 with a recipient of care in an individual's permanent or temporary
3 residence;
4 (4) A person furnishing or delivering home medical supplies or
5 equipment that does not involve the provision of services beyond
6 those necessary to deliver, set up, and monitor the proper
7 functioning of the equipment and educate the user on its proper use;
8 (5) A person who provides services through a contract with a
9 licensed agency;
10 (6) An employee or volunteer of a licensed agency who provides
11 services only as an employee or volunteer;
12 (7) Facilities and institutions, including but not limited to
13 nursing homes under chapter 18.51 RCW, hospitals under chapter 70.41
14 RCW, adult family homes under chapter 70.128 RCW, assisted living
15 facilities under chapter 18.20 RCW, developmental disability
16 residential programs under chapter 71A.12 RCW, other entities
17 licensed under chapter 71.12 RCW, or other licensed facilities and
18 institutions, only when providing services to persons residing within
19 the facility or institution;
20 (8) Local and combined city-county health departments providing
21 services under chapters 70.05 and 70.08 RCW;
22 (9) An individual providing care to ill individuals, individuals
23 with disabilities, or vulnerable individuals through a contract with
24 the department of social and health services;
25 (10) Nursing homes, hospitals, or other institutions, agencies,
26 organizations, or persons that contract with licensed home health,
27 hospice, or home care agencies for the delivery of services;
28 (11) In-home assessments of an ill individual, an individual with
29 a disability, or a vulnerable individual that does not result in
30 regular ongoing care at home;
31 (12) Services conducted by and for the adherents of a church or
32 religious denomination that rely upon spiritual means alone through
33 prayer for healing in accordance with the tenets and practices of
34 such church or religious denomination and the bona fide religious
35 beliefs genuinely held by such adherents;
36 (13) A medicare-approved dialysis center operating a medicare-
37 approved home dialysis program;
38 (14) A person providing case management services. For the
39 purposes of this subsection, "case management" means the assessment,
40 coordination, authorization, planning, training, and monitoring of
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 1 home health, hospice, and home care, and does not include the direct
2 provision of care to an individual;
3 (15) Pharmacies licensed under RCW 18.64.043 that deliver
4 prescription drugs and durable medical equipment that does not
5 involve the use of professional services beyond those authorized to
6 be performed by licensed pharmacists pursuant to chapter 18.64 RCW
7 and those necessary to set up and monitor the proper functioning of
8 the equipment and educate the person on its proper use;
9 (16) A volunteer hospice complying with the requirements of RCW
10 70.127.050;
11 (17) A person who provides home care services without
12 compensation;
13 (18) Nursing homes that provide telephone or web-based
14 transitional care management services; ((and))
15 (19) A rural health clinic providing health services in a home
16 health shortage area as declared by the department pursuant to 42
17 C.F.R. Sec. 405.2416; and
18 (20) Hospital at-home services provided by a hospital pursuant to
19 section 2 of this act.
20 Sec. 5. RCW 70.38.111 and 2021 c 277 s 1 are each amended to
21 read as follows:
22 (1) The department shall not require a certificate of need for
23 the offering of an inpatient tertiary health service by:
24 (a) A health maintenance organization or a combination of health
25 maintenance organizations if (i) the organization or combination of
26 organizations has, in the service area of the organization or the
27 service areas of the organizations in the combination, an enrollment
28 of at least fifty thousand individuals, (ii) the facility in which
29 the service will be provided is or will be geographically located so
30 that the service will be reasonably accessible to such enrolled
31 individuals, and (iii) at least seventy-five percent of the patients
32 who can reasonably be expected to receive the tertiary health service
33 will be individuals enrolled with such organization or organizations
34 in the combination;
35 (b) A health care facility if (i) the facility primarily provides
36 or will provide inpatient health services, (ii) the facility is or
37 will be controlled, directly or indirectly, by a health maintenance
38 organization or a combination of health maintenance organizations
39 which has, in the service area of the organization or service areas
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 1 of the organizations in the combination, an enrollment of at least
2 fifty thousand individuals, (iii) the facility is or will be
3 geographically located so that the service will be reasonably
4 accessible to such enrolled individuals, and (iv) at least seventy-
5 five percent of the patients who can reasonably be expected to
6 receive the tertiary health service will be individuals enrolled with
7 such organization or organizations in the combination; or
8 (c) A health care facility (or portion thereof) if (i) the
9 facility is or will be leased by a health maintenance organization or
10 combination of health maintenance organizations which has, in the
11 service area of the organization or the service areas of the
12 organizations in the combination, an enrollment of at least fifty
13 thousand individuals and, on the date the application is submitted
14 under subsection (2) of this section, at least fifteen years remain
15 in the term of the lease, (ii) the facility is or will be
16 geographically located so that the service will be reasonably
17 accessible to such enrolled individuals, and (iii) at least seventy-
18 five percent of the patients who can reasonably be expected to
19 receive the tertiary health service will be individuals enrolled with
20 such organization;
21 if, with respect to such offering or obligation by a nursing home,
22 the department has, upon application under subsection (2) of this
23 section, granted an exemption from such requirement to the
24 organization, combination of organizations, or facility.
25 (2) A health maintenance organization, combination of health
26 maintenance organizations, or health care facility shall not be
27 exempt under subsection (1) of this section from obtaining a
28 certificate of need before offering a tertiary health service unless:
29 (a) It has submitted at least thirty days prior to the offering
30 of services reviewable under RCW 70.38.105(4)(d) an application for
31 such exemption; and
32 (b) The application contains such information respecting the
33 organization, combination, or facility and the proposed offering or
34 obligation by a nursing home as the department may require to
35 determine if the organization or combination meets the requirements
36 of subsection (1) of this section or the facility meets or will meet
37 such requirements; and
38 (c) The department approves such application. The department
39 shall approve or disapprove an application for exemption within
40 thirty days of receipt of a completed application. In the case of a
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 1 proposed health care facility (or portion thereof) which has not
2 begun to provide tertiary health services on the date an application
3 is submitted under this subsection with respect to such facility (or
4 portion), the facility (or portion) shall meet the applicable
5 requirements of subsection (1) of this section when the facility
6 first provides such services. The department shall approve an
7 application submitted under this subsection if it determines that the
8 applicable requirements of subsection (1) of this section are met.
9 (3) A health care facility (or any part thereof) with respect to
10 which an exemption was granted under subsection (1) of this section
11 may not be sold or leased and a controlling interest in such facility
12 or in a lease of such facility may not be acquired and a health care
13 facility described in subsection (1)(c) of this section which was
14 granted an exemption under subsection (1) of this section may not be
15 used by any person other than the lessee described in subsection
16 (1)(c) of this section unless:
17 (a) The department issues a certificate of need approving the
18 sale, lease, acquisition, or use; or
19 (b) The department determines, upon application, that (i) the
20 entity to which the facility is proposed to be sold or leased, which
21 intends to acquire the controlling interest, or which intends to use
22 the facility is a health maintenance organization or a combination of
23 health maintenance organizations which meets the requirements of
24 subsection (1)(a)(i) of this section, and (ii) with respect to such
25 facility, meets the requirements of subsection (1)(a)(ii) or (iii) of
26 this section or the requirements of subsection (1)(b)(i) and (ii) of
27 this section.
28 (4) In the case of a health maintenance organization, an
29 ambulatory care facility, or a health care facility, which