Washington Administrative Code › Title 246 - Health, Department of › FACILITY STANDARDS AND LICENSING › Chapter 246-310 - Certificate of need › Section 246-310-270 - Ambulatory surgery

Current through Register Vol. 24-14, July 15, 2024
(1) To receive
				approval, an ambulatory surgical facility must meet the following standards in
				addition to applicable review criteria in WAC
				246-310-210,
				246-310-220,
				246-310-230, and
				246-310-240.
(2) The area to be used to plan for operating
				rooms and ambulatory surgical facilities is the secondary health services
				planning area.
(3) Secondary health
				services planning areas are: San Juan, Whatcom, East Skagit, Whidbey-Fidalgo,
				Western North Olympic, East Clallam, East Jefferson, North Snohomish, Central
				Snohomish, East Snohomish, Southwest Snohomish, Kitsap, North King, East King,
				Central King, Southwest King, Southeast King, Central Pierce, West Pierce, East
				Pierce, Mason, West Grays Harbor, Southeast Grays Harbor, Thurston, North
				Pacific, South Pacific, West Lewis, East Lewis, Cowlitz-Wahkiakum-Skamania,
				Clark, West Klickitat, East Klickitat, Okanogan, Chelan-Douglas, Grant,
				Kittitas, Yakima, Benton-Franklin, Ferry, North Stevens, North Pend Oreille,
				South Stevens, South Pend Oreille, Southwest Lincoln, Central Lincoln, Spokane,
				Southwest Adams, Central Adams, Central Whitman, East Whitman, Walla Walla,
				Columbia, Garfield, and Asotin.
(4)
				Outpatient operating rooms should ordinarily not be approved in planning areas
				where the total number of operating rooms available for both inpatient and
				outpatient surgery exceeds the area need.
(5) When a need exists in planning areas for
				additional outpatient operating room capacity, preference shall be given to
				dedicated outpatient operating rooms.
(6) An ambulatory surgical facility shall
				have a minimum of two operating rooms.
(7) Ambulatory surgical facilities shall
				document and provide assurances of implementation of policies to provide access
				to individuals unable to pay consistent with charity care levels provided by
				hospitals affected by the proposed ambulatory surgical facility. The amount of
				an ambulatory surgical facility's annual revenue utilized to finance charity
				care shall be at least equal to or greater than the average percentage of total
				patient revenue, other than medicare or medicaid, that affected hospitals in
				the planning area utilized to provide charity care in the last available
				reporting year.
(8) The need for
				operating rooms will be determined using the method identified in subsection
				(9) of this section.
(9) Operating
				room need in a planning area shall be determined using the following method:
(a) Existing capacity.
(i) Assume the annual capacity of one
				operating room located in a hospital and not dedicated to outpatient surgery is
				ninety-four thousand two hundred fifty minutes. This is derived from scheduling
				forty-four hours per week, fifty-one weeks per year (allowing for five weekday
				holidays), a fifteen percent loss for preparation and clean-up time, and
				fifteen percent time loss to allow schedule flexibility. The resulting seventy
				percent productive time is comparable to the previously operating hospital
				commission's last definition of "billing minutes" which is the time lapse from
				administration of anesthesia until surgery is completed.
(ii) Assume the annual capacity of one
				operating room dedicated to ambulatory surgery is sixty-eight thousand eight
				hundred fifty minutes. The derivation is the same as (a)(i) of this subsection
				except for twenty-five percent loss for prep/clean-up time and scheduling is
				for a thirty-seven and one-half hour week. Divide the capacity minutes by the
				average minutes per outpatient surgery (see (a)(vii) of this subsection). Where
				survey data are unavailable, assume fifty minutes per outpatient surgery,
				resulting in a capacity for one thousand three hundred seventy-seven outpatient
				surgeries per room per year.
(iii)
				Calculate the total annual capacity (in number of surgeries) of all dedicated
				outpatient operating rooms in the area.
(iv) Calculate the total annual capacity (in
				number of minutes) of the remaining inpatient and outpatient operating rooms in
				the area, including dedicated specialized rooms except for twenty-four hour
				dedicated emergency rooms. When dedicated emergency operating rooms are
				excluded, emergency or minutes should also be excluded when calculating the
				need in an area. Exclude cystoscopic and other special purpose rooms (e.g.,
				open heart surgery) and delivery rooms.