============================================================================== CERTIFICATE OF NEED INTELLIGENCE BRIEF: WASHINGTON The Rojas Report | conlaws.rojasreport.com/states/washington/ ============================================================================== State: Washington (WA) Score: 100/100 Tier: Most Restrictive Rank: 43 of 51 jurisdictions ------------------------------------------------------------------------------ SUMMARY ------------------------------------------------------------------------------ In-depth analysis of Washington's Certificate of Need (CON) program, its economic impact, and the key players benefiting from the regulations. ------------------------------------------------------------------------------ SCOPE OF REGULATION ------------------------------------------------------------------------------ * Services Regulated * Regulated Services & Facilities * Hospitals & Nursing Homes * Ambulatory Surgical Centers * Home Health & Hospice Agencies ------------------------------------------------------------------------------ APPLICATION PROCESS ------------------------------------------------------------------------------ The Application Gauntlet The process is lengthy and expensive, giving incumbent providers ample opportunity to block new competitors. ------------------------------------------------------------------------------ MARKET CONCENTRATION ------------------------------------------------------------------------------ Five systems control 40% of Washington's hospitals, with local monopolies even more pronounced. $81.4 billion in drug discounts. $66.4 billion in gross margin. Zero disclosure requirements. ------------------------------------------------------------------------------ REFORM STATUS ------------------------------------------------------------------------------ Washington has not repealed its CON law. Instead, the state continues to actively amend and update rules and fees, signaling a commitment to maintaining the regulatory barrier. The program remains one of the most comprehensive and restrictive in the United States. $81.4 billion in drug discounts. $66.4 billion in gross margin. Zero disclosure requirements. ------------------------------------------------------------------------------ CASE LAW / DENIALS ------------------------------------------------------------------------------ A proposal for a new three-room ambulatory surgical facility in Richland was denied by the Department of Health. The state determined the project was not consistent with its criteria for need, financial feasibility, and cost containment—classic CON gatekeeping that protects existing hospitals from a new, specialized competitor. ============================================================================== Source: The Rojas Report | conlaws.rojasreport.com/states/washington/ Data: Cicero Institute, NASHP, FTC, DOJ, CMS, state health departments Generated: April 2026 ==============================================================================