title: RCW 70.168.015

text:
As used in this chapter, the following terms have the meanings indicated unless the context clearly requires otherwise.
(1) "Cardiac" means acute coronary syndrome, an umbrella term used to cover any group of clinical symptoms compatible with acute myocardial ischemia, which is chest discomfort or other symptoms due to insufficient blood supply to the heart muscle resulting from coronary artery disease. "Cardiac" also includes out-of-hospital cardiac arrest, which is the cessation of mechanical heart activity as assessed by emergency medical services personnel, or other acute heart conditions.
(2) "Communications system" means a radio and landline network which provides rapid public access, coordinated central dispatching of services, and coordination of personnel, equipment, and facilities in an emergency medical services and trauma care system.
(3) "Department" means the department of health.
(4) "Designated trauma care service" means a level I, II, III, IV, or V trauma care service or level I, II, or III pediatric trauma care service or level I, I-pediatric, II, or III trauma-related rehabilitative service.
(5) "Designation" means a formal determination by the department that hospitals or health care facilities are capable of providing designated trauma care services as authorized in RCW 70.168.070.
(6) "Emergency medical service" means medical treatment and care that may be rendered at the scene of any medical emergency or while transporting any patient in an ambulance to an appropriate medical facility, including ambulance transportation between medical facilities.
(7) "Emergency medical services and trauma care planning and service regions" means geographic areas established by the department under this chapter.
(8) "Emergency medical services and trauma care system plan" means a statewide plan that identifies statewide emergency medical services and trauma care objectives and priorities and identifies equipment, facility, personnel, training, and other needs required to create and maintain a statewide emergency medical services and trauma care system. The plan also includes a plan of implementation that identifies the state, regional, and local activities that will create, operate, maintain, and enhance the system. The plan is formulated by incorporating the regional emergency medical services and trauma care plans required under this chapter. The plan shall be updated every two years and shall be made available to the state board of health in sufficient time to be considered in preparation of the biennial state health report required in *RCW 43.20.050.
(9) "Emergency medical services medical program director" means a person who is an approved program director as defined by RCW 18.71.205(4).
(10) "Facility patient care protocols" means the written procedures adopted by the medical staff that direct the care of the patient. These procedures shall be based upon the assessment of the patients' medical needs. The procedures shall follow minimum statewide standards for trauma care services.
(11) "Hospital" means a facility licensed under chapter 70.41 RCW, or comparable health care facility operated by the federal government or located and licensed in another state.
(12) "Level I-pediatric rehabilitative services" means rehabilitative services as established in RCW 70.168.060. Facilities providing level I-pediatric rehabilitative services provide the same services as facilities authorized to provide level I rehabilitative services except these services are exclusively for children under the age of fifteen years.
(13) "Level I pediatric trauma care services" means pediatric trauma care services as established in RCW 70.168.060. Hospitals providing level I services shall provide definitive, comprehensive, specialized care for pediatric trauma patients and shall also provide ongoing research and health care professional education in pediatric trauma care.
(14) "Level I rehabilitative services" means rehabilitative services as established in RCW 70.168.060. Facilities providing level I rehabilitative services provide rehabilitative treatment to patients with traumatic brain injuries, spinal cord injuries, complicated amputations, and other diagnoses resulting in functional impairment, with moderate to severe impairment or complexity. These facilities serve as referral facilities for facilities authorized to provide level II and III rehabilitative services.
(15) "Level I trauma care services" means trauma care services as established in RCW 70.168.060. Hospitals providing level I services shall have specialized trauma care teams and provide ongoing research and health care professional education in trauma care.
(16) "Level II pediatric trauma care services" means pediatric trauma care services as established in RCW 70.168.060. Hospitals providing level II services shall provide initial stabilization and evaluation of pediatric trauma patients and provide comprehensive general medicine and surgical care to pediatric patients who can be maintained in a stable or improving condition without the specialized care available in the level I hospital. Complex surgeries and research and health care professional education in pediatric trauma care activities are not required.
(17) "Level II rehabilitative services" means rehabilitative services as established in RCW 70.168.060. Facilities providing level II rehabilitative services treat individuals with musculoskeletal trauma, peripheral nerve lesions, lower extremity amputations, and other diagnoses resulting in functional impairment in more than one functional area, with moderate to severe impairment or complexity.
(18) "Level II trauma care services" means trauma care services as established in RCW 70.168.060. Hospitals providing level II services shall be similar to those provided by level I hospitals, although complex surgeries and research and health care professional education activities are not required to be provided.
(19) "Level III pediatric trauma care services" means pediatric trauma care services as established in RCW 70.168.060. Hospitals providing level III services shall provide initial evaluation and stabilization of patients. The range of pediatric trauma care services provided in level III hospitals are not as comprehensive as level I and II hospitals.
(20) "Level III rehabilitative services" means rehabilitative services as established in RCW 70.168.060. Facilities providing level III rehabilitative services provide treatment to individuals with musculoskeletal injuries, peripheral nerve injuries, uncomplicated lower extremity amputations, and other diagnoses resulting in functional impairment in more than one functional area but with minimal to moderate impairment or complexity.
(21) "Level III trauma care services" means trauma care services as established in RCW 70.168.060. The range of trauma care services provided by level III hospitals are not as comprehensive as level I and II hospitals.
(22) "Level IV trauma care services" means trauma care services as established in RCW 70.168.060.
(23) "Level V trauma care services" means trauma care services as established in RCW 70.168.060. Facilities providing level V services shall provide stabilization and transfer of all patients with potentially life-threatening injuries.
(24) "Patient care procedures" means written operating guidelines adopted by the regional emergency medical services and trauma care council, in consultation with local emergency medical services and trauma care councils, emergency communication centers, and the emergency medical services medical program director, in accordance with minimum statewide standards. The patient care procedures shall identify the level of medical care personnel to be dispatched to an emergency scene, procedures for triage of patients, the level of trauma care facility, mental health facility, or chemical dependency program to first receive the patient, and the name and location of other trauma care facilities, mental health facilities, or chemical dependency programs to receive the patient should an interfacility transfer be necessary. Procedures on interfacility transfer of patients shall be consistent with the transfer procedures required in chapter 70.170 RCW.
(25) "Pediatric trauma patient" means trauma patients known or estimated to be less than fifteen years of age.
(26) "Prehospital" means emergency medical care or transportation rendered to patients prior to hospital admission or during interfacility transfer by licensed ambulance or aid service under chapter 18.73 RCW, by personnel certified to provide emergency medical care under chapters 18.71 and 18.73 RCW, or by facilities providing level V trauma care services as provided for in this chapter.
(27) "Prehospital patient care protocols" means the written procedures adopted by the emergency medical services medical program director that direct the out-of-hospital emergency care of the emergency patient which includes the trauma patient. These procedures shall be based upon the assessment of the patients' medical needs and the treatment to be provided for serious conditions. The procedures shall meet or exceed statewide minimum standards for trauma and other prehospital care services.
(28) "Rehabilitative services" means a formal program of multidisciplinary, coordinated, and integrated services for evaluation, treatment, education, and training to help individuals with disabling impairments achieve and maintain optimal functional independence in physical, psychosocial, social, vocational, and avocational realms. Rehabilitation is indicated for the trauma patient who has sustained neurologic or musculoskeletal injury and who needs physical or cognitive intervention to return to home, work, or society.
(29) "Secretary" means the secretary of the department of health.
(30) "Trauma" means a major single or multisystem injury requiring immediate medical or surgical intervention or treatment to prevent death or permanent disability.
(31) "Trauma care system" means an organized approach to providing care to trauma patients that provides personnel, facilities, and equipment for effective and coordinated trauma care. The trauma care system shall: Identify facilities with specific capabilities to provide care, triage trauma victims at the scene, and require that all trauma victims be sent to an appropriate trauma facility. The trauma care system includes prevention, prehospital care, hospital care, and rehabilitation.
(32) "Triage" means the sorting of patients in terms of disposition, destination, or priority. Triage of prehospital trauma victims requires identifying injury severity so that the appropriate care level can be readily assessed according to patient care guidelines.
(33) "Verification" means the identification of prehospital providers who are capable of providing verified trauma care services and shall be a part of the licensure process required in chapter 18.73 RCW.
(34) "Verified trauma care service" means prehospital service as provided for in RCW 70.168.080, and identified in the regional emergency medical services and trauma care plan as required by RCW 70.168.100.
[ 2015 c 157 s 2. Prior: 2010 c 52 s 2; 1990 c 269 s 4.]
Notes:
*Reviser's note: RCW 43.20.050 was amended by 2011 c 27 s 1, eliminating the "state health report."
Findings—Intent—2010 c 52: "(1) The legislature finds that:
(a) In 2006, the governor's emergency medical services and trauma care steering committee charged the emergency cardiac and stroke work group with assessing the burden of acute coronary syndrome, otherwise known as heart attack, cardiac arrest, and stroke and the care that people receive for these acute cardiovascular events in Washington.
(b) The work group's report found that:
(i) Despite falling death rates, heart disease and stroke were still the second and third leading causes of death in 2005. All cardiovascular diseases accounted for thirty-four percent of deaths, surpassing all other causes of death.
(ii) Cardiovascular diseases have a substantial social and economic impact on individuals and families, as well as the state's health and long-term care systems. Although many people who survive acute cardiac and stroke events have significant physical and cognitive disability, early evidence-based treatments can help more people return to their productive lives.
(iii) Heart disease and stroke are among the most costly medical conditions at nearly four billion dollars per year for hospitalization and long-term care alone.
(iv) The age group at highest risk for heart disease or stroke, people sixty-five and older, is projected to double by 2030, potentially doubling the social and economic impact of heart disease and stroke in Washington. Early recognition is important, as Washington demographics indicate a significant occurrence of acute coronary syndromes by the age of fifty-five.
(c) The assessment of emergency cardiac and stroke care found:
(i) Many cardiac and stroke patients are not receiving evidence-based treatments;
(ii) Access to diagnostic and treatment resources varies greatly, especially for rural parts of the state;
(iii) Training, protocols, procedures, and resources in dispatch services, emergency medical services, and hospitals vary significantly;
(iv) Cardiac mortality rates vary widely depending on hospital and regional resources; and
(v) Advances in technology and streamlined approaches to care can significantly improve emergency cardiac and stroke care, but many people do not get the benefit of these treatments.
(d) Time is critical throughout the chain of survival, from dispatch of emergency medical services, to transport, to the emergency room, for emergency cardiac and stroke patients. The minutes after the onset of heart attack, cardiac arrest, and stroke are as important as the "golden hour" in trauma. When treatment is delayed, more brain or heart tissue dies. Timely treatment can mean the difference between returning to work or becoming permanently disabled, living at home, or living in a nursing home. It can be the difference between life and death. Ensuring most patients will get lifesaving care in time requires preplanning and an organized system of care.
(e) Many other states have improved systems of care to respond to and treat acute cardiac and stroke events, similar to improvements in trauma care in Washington.
(f) Some areas of Washington have deployed local systems to respond to and treat acute cardiac and stroke events.
(2) It is the intent of the legislature to support efforts to improve emergency cardiac and stroke care in Washington through an evidence-based coordinated system of care." [ 2010 c 52 s 1.]


doc_type: statute

jurisdiction: wa

title: RCW 70.168.020

text:
(1) There is hereby created an emergency medical services and trauma care steering committee composed of representatives of individuals knowledgeable in emergency medical services and trauma care, including emergency medical providers such as physicians, nurses, hospital personnel, emergency medical technicians, paramedics, ambulance services, a member of the emergency medical services licensing and certification advisory committee, local government officials, state officials, consumers, and persons affiliated professionally with health science schools. The secretary shall appoint members of the steering committee. Members shall be appointed for a period of three years. The department shall provide administrative support to the committee. All appointive members of the committee, in the performance of their duties, may be entitled to receive travel expenses as provided in RCW 43.03.050 and 43.03.060. The secretary may remove members from the committee who have three unexcused absences from committee meetings. The secretary shall fill any vacancies of the committee in a timely manner. The terms of those members representing the same field shall not expire at the same time.
The committee shall elect a chair and a vice chair whose terms of office shall be for one year each. The chair shall be ineligible for reelection after serving four consecutive terms.
The committee shall meet on call by the secretary or the chair.
(2) The emergency medical services and trauma care steering committee shall:
(a) Advise the department regarding emergency medical services and trauma care needs throughout the state.
(b) Review the regional emergency medical services and trauma care plans and recommend changes to the department before the department adopts the plans.
(c) Review proposed departmental rules for emergency medical services and trauma care.
(d) Recommend modifications in rules regarding emergency medical services and trauma care.
[ 2011 1st sp.s. c 21 s 28; 2000 c 93 s 20; 1990 c 269 s 5; 1988 c 183 s 2.]
Notes:
Effective date—2011 1st sp.s. c 21: See note following RCW 72.23.025.

license: public-domain-government-work

rule_set: Revised Code of Washington

code: rcw

unit: section

court: Washington State Legislature


title: RCW 70.168.030

text:
(1) Upon the recommendation of the steering committee, the director of the office of financial management shall contract with an independent party for an analysis of the state's trauma system.
(2) The analysis shall contain at a minimum, the following:
(a) The identification of components of a functional statewide trauma care system, including standards; and
(b) An assessment of the current trauma care program compared with the functional statewide model identified in subsection (a) of this section, including an analysis of deficiencies and reasons for the deficiencies.
(3) The analysis shall provide a design for a statewide trauma care system based on the findings of the committee under subsection (2) of this section, with a plan for phased-in implementation. The plan shall include, at a minimum, the following:
(a) Responsibility for implementation;
(b) Administrative authority at the state, regional, and local levels;
(c) Facility, equipment, and personnel standards;
(d) Triage and care criteria;
(e) Data collection and use;
(f) Cost containment strategies;
(g) System evaluation; and
(h) Projected costs.
[ 1998 c 245 s 117; 1988 c 183 s 3.]

catchline: Analysis of state's trauma system—Plan.


title: RCW 70.168.040

text:
(1) The emergency medical services and trauma care system trust account is hereby created in the state treasury. Moneys shall be transferred to the emergency medical services and trauma care system trust account from the public safety education account or other sources as appropriated, and as collected under RCW 46.63.110(7) and 46.68.440. Disbursements shall be made by the department subject to legislative appropriation. Expenditures may be made only for the purposes of the state trauma care system under this chapter, including emergency medical services, trauma care services, rehabilitative services, and the planning and development of related services under this chapter and for reimbursement by the health care authority for trauma care services provided by designated trauma centers.
(2) During the 2025-2027 fiscal biennium, funds may be used for staffing and resources necessary for the Franklin county public hospital district #1 to provide health services as part of medical transport operations services, including services to the Coyote Ridge corrections center.
[ 2026 c 268 s 932; 2011 1st sp.s. c 15 s 86; 2010 c 161 s 1158; 2002 c 371 s 922; 1997 c 331 s 2; 1990 c 269 s 17; 1988 c 183 s 4.]
Notes:
Effective date—2026 c 268: See note following RCW 28B.15.210.
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
Effective date—Intent—Legislation to reconcile chapter 161, Laws of 2010 and other amendments made during the 2010 legislative session—2010 c 161: See notes following RCW 46.04.013.
Severability—Effective date—2002 c 371: See notes following RCW 9.46.100.
Effective date—1997 c 331: See note following RCW 70.168.135.

catchline: Emergency medical services and trauma care system trust account.


title: RCW 70.168.050

text:
(1) The department, in consultation with, and having solicited the advice of, the emergency medical services and trauma care steering committee, shall establish the Washington state emergency medical services and trauma care system.
(2) The department shall adopt rules consistent with this chapter to carry out the purpose of this chapter. All rules shall be adopted in accordance with chapter 34.05 RCW. All rules and procedures adopted by the department shall minimize paperwork and compliance requirements for facilities and other participants. The department shall assure an opportunity for consultation, review, and comment by the public and providers of emergency medical services and trauma care before adoption of rules. When developing rules to implement this chapter the department shall consider the report of the Washington state trauma project established under chapter 183, Laws of 1988. Nothing in this chapter requires the department to follow any specific recommendation in that report except as it may also be included in this chapter.
(3) The department may apply for, receive, and accept gifts and other payments, including property and service, from any governmental or other public or private entity or person, and may make arrangements as to the use of these receipts, including any activities related to the design, maintenance, or enhancements of the emergency medical services and trauma care system in the state. The department shall make available upon request to the appropriate legislative committees information concerning the source, amount, and use of such gifts or payments.
[ 1990 c 269 s 3.]

catchline: Emergency medical services and trauma care system—Department to establish—Rule making—Gifts.


title: RCW 70.168.060

text:
The department, in consultation with and having solicited the advice of the emergency medical services and trauma care steering committee, shall:
(1) Establish the following on a statewide basis:
(a) By September 1990, minimum standards for facility, equipment, and personnel for level I, II, III, IV, and V trauma care services;
(b) By September 1990, minimum standards for facility, equipment, and personnel for level I, I-pediatric, II, and III trauma-related rehabilitative services;
(c) By September 1990, minimum standards for facility, equipment, and personnel for level I, II, and III pediatric trauma care services;
(d) By September 1990, minimum standards required for verified prehospital trauma care services, including equipment and personnel;
(e) Personnel training requirements and programs for providers of trauma care. The department shall design programs which are accessible to rural providers including on-site training;
(f) Statewide emergency medical services and trauma care system objectives and priorities;
(g) Minimum standards for the development of facility patient care protocols and prehospital patient care protocols and patient care procedures;
(h) By July 1991, minimum standards for an effective emergency medical communication system;
(i) Minimum standards for an effective emergency medical services transportation system; and
(j) By July 1991, establish a program for emergency medical services and trauma care research and development;
(2) Establish statewide standards, personnel training requirements and programs, system objectives and priorities, protocols and guidelines as required in subsection (1) of this section, by utilizing those standards adopted in the report of the Washington trauma advisory committee as authorized by chapter 183, Laws of 1988. In establishing standards for level IV or V trauma care services the department may adopt similar standards adopted for services provided in rural health care facilities authorized in chapter 70.175 RCW. The department may modify standards, personnel training requirements and programs, system objectives and priorities, and guidelines in rule if the department determines that such modifications are necessary to meet federal and other state requirements or are essential to allow the department and others to establish the system or should it determine that public health considerations or efficiencies in the delivery of emergency medical services and trauma care warrant such modifications;
(3) Designate emergency medical services and trauma care planning and service regions as provided for in this chapter;
(4) By July 1, 1992, establish the minimum and maximum number of hospitals and health care facilities in the state and within each emergency medical services and trauma care planning and service region that may provide designated trauma care services based upon approved regional emergency medical services and trauma care plans;
(5) By July 1, 1991, establish the minimum and maximum number of prehospital providers in the state and within each emergency medical services and trauma care planning and service region that may provide verified trauma care services based upon approved regional emergency medical services and trauma care plans;
(6) By July 1993, begin the designation of hospitals and health care facilities to provide designated trauma care services in accordance with needs identified in the statewide emergency medical services and trauma care plan;
(7) By July 1990, adopt a format for submission of the regional plans to the department;
(8) By July 1991, begin the review and approval of regional emergency medical services and trauma care plans;
(9) By July 1992, prepare regional plans for those regions that do not submit a regional plan to the department that meets the requirements of this chapter;
(10) By October 1992, prepare and implement the statewide emergency medical services and trauma care system plan incorporating the regional plans;
(11) Coordinate the statewide emergency medical services and trauma care system to assure integration and smooth operation between the regions;
(12) Facilitate coordination between the emergency medical services and trauma care steering committee and the emergency medical services licensing and certification advisory committee;
(13) Monitor the statewide emergency medical services and trauma care system;
(14) Conduct a study of all costs, charges, expenses, and levels of reimbursement associated with providers of trauma care services, and provide its findings and any recommendations regarding adequate and equitable reimbursement to trauma care providers to the legislature by July 1, 1991;
(15) Monitor the level of public and private payments made on behalf of trauma care patients to determine whether health care providers have been adequately reimbursed for the costs of care rendered such persons;
(16) By July 1991, design and establish the statewide trauma care registry as authorized in RCW 70.168.090 to (a) assess the effectiveness of emergency medical services and trauma care delivery, and (b) modify standards and other system requirements to improve the provision of emergency medical services and trauma care;
(17) By July 1991, develop patient outcome measures to assess the effectiveness of emergency medical services and trauma care in the system;
(18) By July 1993, develop standards for regional emergency medical services and trauma care quality assurance programs required in RCW 70.168.090;
(19) Administer funding allocated to the department for the purpose of creating, maintaining, or enhancing the statewide emergency medical services and trauma care system; and
(20) By October 1990, begin coordination and development of trauma prevention and education programs.
[ 1990 c 269 s 8.]

catchline: Department duties—Timelines.


title: RCW 70.168.070

text:
Any hospital or health care facility that desires to be authorized to provide a designated trauma care service shall request designation from the department. Designation involves a contractual relationship between the state and a hospital or health care facility whereby each agrees to maintain a level of commitment and resources sufficient to meet responsibilities and standards required by the statewide emergency medical services and trauma care system plan. By January 1992, the department shall determine by rule the manner and form of such requests. Upon receiving a request, the department shall review the request to determine whether the hospital or health care facility is in compliance with standards for the trauma care service or services for which designation is desired. If requests are received from more than one hospital or health care facility within the same emergency medical planning and trauma care planning and service region, the department shall select the most qualified applicant or applicants to be selected through a competitive process. Any applicant not designated may request a hearing to review the decision.
Designations are valid for a period of three years and are renewable upon receipt of a request for renewal prior to expiration from the hospital or health care facility. When an authorization for designation is due for renewal other hospitals and health care facilities in the area may also apply and compete for designation. Regional emergency medical and trauma care councils shall be notified promptly of designated hospitals and health care facilities in their region so they may incorporate them into the regional plan as required by this chapter. The department may revoke or suspend the designation should it determine that the hospital or health care facility is substantially out of compliance with the standards and has refused or been unable to comply after a reasonable period of time has elapsed. The department shall promptly notify the regional emergency medical and trauma care planning and service region of suspensions or revocations. Any facility whose designation has been revoked or suspended may request a hearing to review the action by the department as provided for in chapter 34.05 RCW.
As a part of the process to designate and renew the designation of hospitals authorized to provide level I, II, or III trauma care services or level I, II, and III pediatric trauma care services, the department shall contract for on-site reviews of such hospitals to determine compliance with required standards. The department may contract for on-site reviews of hospitals and health care facilities authorized to provide level IV or V trauma care services or level I, I-pediatric, II, or III trauma-related rehabilitative services to determine compliance with required standards. Members of on-site review teams and staff included in site visits are exempt from chapter 42.56 RCW. They may not divulge and cannot be subpoenaed to divulge information obtained or reports written pursuant to this section in any civil action, except, after in camera review, pursuant to a court order which provides for the protection of sensitive information of interested parties including the department: (1) In actions arising out of the department's designation of a hospital or health care facility pursuant to this section; (2) in actions arising out of the department's revocation or suspension of designation status of a hospital or health care facility under this section; or (3) in actions arising out of the restriction or revocation of the clinical or staff privileges of a health care provider as defined in RCW 7.70.020 (1) and (2), subject to any further restrictions on disclosure in RCW 4.24.250 that may apply. Information that identifies individual patients shall not be publicly disclosed without the patient's consent. When a facility requests designation for more than one service, the department may coordinate the joint consideration of such requests.
The department may establish fees to help defray the costs of this section, though such fees shall not be assessed to health care facilities authorized to provide level IV and V trauma care services.
This section shall not restrict the authority of a hospital or a health care provider licensed under Title 18 RCW to provide services which it has been authorized to provide by state law.
[ 2005 c 274 s 343; 1990 c 269 s 9.]

catchline: Provision of trauma care service—Designation.


title: RCW 70.168.080

text:
(1) Any provider desiring to provide a verified prehospital trauma care service shall indicate on the licensing application how they meet the standards required for verification as a provider of this service. The department shall notify the regional emergency medical services and trauma care councils of the providers of verified trauma care services in their regions. The department may conduct on-site reviews of prehospital providers to assess compliance with the applicable standards.
(2) Should the department determine that a prehospital provider is substantially out of compliance with the standards, the department shall notify the regional emergency medical services and trauma care council. If the failure of a prehospital provider to comply with the applicable standards results in the region being out of compliance with its regional plan, the council shall take such steps necessary to assure the region is brought into compliance within a reasonable period of time. The council may seek assistance and funding from the department and others to provide training or grants necessary to bring a prehospital provider into compliance. The council may appeal to the department for modification of the regional plan if it is unable to assure continued compliance with the regional plan. The department may authorize modification of the plan if such modifications meet the requirements of this chapter. The department may suspend or revoke the authorization of a prehospital provider to provide a verified prehospital service if the provider has refused or been unable to comply after a reasonable period of time has elapsed. The council shall be notified promptly of any revocations or suspensions. Any prehospital provider whose verification has been suspended or revoked may request a hearing to review the action by the department as provided for in chapter 34.05 RCW.
(3) The department may grant a variance from provisions of this section if the department determines: (a) That no detriment to public health and safety will result from the variance, and (b) compliance with provisions of this section will cause a reduction or loss of existing prehospital services. Variances may be granted for a period not to exceed one year. A variance may be renewed by the department. If a renewal is granted, a plan of compliance shall be prepared specifying steps necessary to bring a provider or region into compliance and expected date of compliance.
(4) This section shall not restrict the authority of a provider licensed under Title 18 RCW to provide services which it has been authorized to provide by state law.
[ 1990 c 269 s 10.]

catchline: Prehospital trauma care service—Verification—Compliance—Variance.


title: RCW 70.168.090

text:
(1)(a) By July 1991, the department shall establish a statewide data registry to collect and analyze data on the incidence, severity, and causes of trauma, including traumatic brain injury. The department shall collect additional data on traumatic brain injury should additional data requirements be enacted by the legislature. The registry shall be used to improve the availability and delivery of prehospital and hospital trauma care services. Specific data elements of the registry shall be defined by rule by the department. To the extent possible, the department shall coordinate data collection from hospitals for the trauma registry with the health care data system authorized in chapter 70.170 RCW. Every hospital, facility, or health care provider authorized to provide level I, II, III, IV, or V trauma care services, level I, II, or III pediatric trauma care services, level I, level I-pediatric, II, or III trauma-related rehabilitative services, and prehospital trauma-related services in the state shall furnish data to the registry. All other hospitals and prehospital providers shall furnish trauma data as required by the department by rule.
(b) The department may respond to requests for data and other information from the registry for special studies and analysis consistent with requirements for confidentiality of patient and quality assurance records. The department may require requestors to pay any or all of the reasonable costs associated with such requests that might be approved.
(2) The department must establish a statewide electronic emergency medical services data system and adopt rules requiring licensed ambulance and aid services to report and furnish patient encounter data to the electronic emergency medical services data system. The data system must be used to improve the availability and delivery of prehospital emergency medical services. The department must establish in rule the specific data elements of the data system and secure transport methods for data. The data collected must include data on suspected drug overdoses for the purposes of including, but not limited to, identifying individuals to engage substance use disorder peer professionals, patient navigators, outreach workers, and other professionals as appropriate to prevent further overdoses and to induct into treatment and provide other needed supports as may be available.
(3) In each emergency medical services and trauma care planning and service region, a regional emergency medical services and trauma care systems quality assurance program shall be established by those facilities authorized to provide levels I, II, and III trauma care services. The systems quality assurance program shall evaluate trauma care delivery, patient care outcomes, and compliance with the requirements of this chapter. The systems quality assurance program may also evaluate emergency cardiac and stroke care delivery. The emergency medical services medical program director and all other health care providers and facilities who provide trauma and emergency cardiac and stroke care services within the region shall be invited to participate in the regional emergency medical services and trauma care quality assurance program.
(4) Data elements related to the identification of individual patient's, provider's and facility's care outcomes shall be confidential, shall be exempt from RCW 42.56.030 through 42.56.570 and * 42.17.350 through 42.17.450, and shall not be subject to discovery by subpoena or admissible as evidence.
(5) Patient care quality assurance proceedings, records, and reports developed pursuant to this section are confidential, exempt from chapter 42.56 RCW, and are not subject to discovery by subpoena or admissible as evidence in any civil action, except, after in camera review, pursuant to a court order which provides for the protection of sensitive information of interested parties including the department: (a) In actions arising out of the department's designation of a hospital or health care facility pursuant to RCW 70.168.070; (b) in actions arising out of the department's revocation or suspension of designation status of a hospital or health care facility under RCW 70.168.070; (c) in actions arising out of the department's licensing or verification of an ambulance or aid service pursuant to RCW 18.73.030 or 70.168.080; (d) in actions arising out of the certification of a medical program director pursuant to RCW 18.71.212; or (e) in actions arising out of the restriction or revocation of the clinical or staff privileges of a health care provider as defined in RCW 7.70.020 (1) and (2), subject to any further restrictions on disclosure in RCW 4.24.250 that may apply. Information that identifies individual patients shall not be publicly disclosed without the patient's consent.
[ 2019 c 314 s 19; 2010 c 52 s 5; 2005 c 274 s 344; 1990 c 269 s 11.]
Notes:
*Reviser's note: RCW 42.17.350 through 42.17.450 were recodified and repealed by chapter 204, Laws of 2010.
Declaration—2019 c 314: See note following RCW 18.22.810.
Findings—Intent—2010 c 52: See note following RCW 70.168.015.

catchline: Statewide data registry—Statewide electronic emergency medical services data system—Quality assurance program—Confidentiality.


title: RCW 70.168.100

text:
Regional emergency medical services and trauma care councils are established. The councils:
(1) By June 1990, shall begin the development of regional emergency medical services and trauma care plans to:
(a) Assess and analyze regional emergency medical services and trauma care needs;
(b) Identify personnel, agencies, facilities, equipment, training, and education to meet regional and local needs;
(c) Identify specific activities necessary to meet statewide standards and patient care outcomes and develop a plan of implementation for regional compliance;
(d) Establish and review agreements with regional providers necessary to meet state standards;
(e) Establish agreements with providers outside the region to facilitate patient transfer;
(f) Include a regional budget;
(g) Establish the number and level of facilities to be designated which are consistent with state standards and based upon availability of resources and the distribution of trauma within the region;
(h) Identify the need for and recommend distribution and level of care of prehospital services to assure adequate availability and avoid inefficient duplication and lack of coordination of prehospital services within the region;
(i) Identify procedures to allow for the appropriate transport of patients to mental health facilities or chemical dependency programs, as informed by the alternative facility guidelines adopted under RCW 70.168.170; and
(j) Include other specific elements defined by the department;
(2) By June 1991, shall begin the submission of the regional emergency medical services and trauma care plan to the department;
(3) Shall advise the department on matters relating to the delivery of emergency medical services and trauma care within the region;
(4) Shall provide data required by the department to assess the effectiveness of the emergency medical services and trauma care system;
(5) May apply for, receive, and accept gifts and other payments, including property and service, from any governmental or other public or private entity or person, and may make arrangements as to the use of these receipts, including any activities related to the design, maintenance, or enhancements of the emergency medical services and trauma care system in the region. The councils shall report in the regional budget the amount, source, and purpose of all gifts and payments.
[ 2015 c 157 s 3; 1990 c 269 s 13.]

catchline: Regional emergency medical services and trauma care councils.


title: RCW 70.168.110

text:
The department shall designate at least eight emergency medical services and trauma care planning and service regions so that all parts of the state are within such an area. These regional designations are to be made on the basis of efficiency of delivery of needed emergency medical services and trauma care.
[ 1990 c 269 s 14; 1987 c 214 s 4; 1973 1st ex.s. c 208 s 6. Formerly RCW 18.73.060.]

catchline: Planning and service regions.


title: RCW 70.168.120

text:
(1) A county or group of counties may create a local emergency medical services and trauma care council composed of representatives of hospital and prehospital trauma care and emergency medical services providers, local elected officials, consumers, local law enforcement officials, and local government agencies involved in the delivery of emergency medical services and trauma care.
(2) The department shall establish regional emergency medical services and trauma care councils and shall appoint members to be comprised of a balance of hospital and prehospital trauma care and emergency medical services providers, local elected officials, consumers, local law enforcement representatives, and local government agencies involved in the delivery of trauma care and emergency medical services recommended by the local emergency medical services and trauma care councils within the region.
(3) Local emergency medical services and trauma care councils shall review, evaluate, and provide recommendations to the regional emergency medical services and trauma care council regarding the provision of emergency medical services and trauma care in the region, and provide recommendations to the regional emergency medical services and trauma care councils on the plan for emergency medical services and trauma care.
[ 1990 c 269 s 15; 1987 c 214 s 6; 1983 c 112 s 8. Formerly RCW 18.73.073.]

catchline: Local and regional emergency medical services and trauma care councils—Power and duties.


title: RCW 70.168.130

text:
(1) The department, with the assistance of the emergency medical services and trauma care steering committee, shall adopt a program for the disbursement of funds for the development, implementation, and enhancement of the emergency medical services and trauma care system. Under the program, the department shall disburse funds to each emergency medical services and trauma care regional council, or their chosen fiscal agent or agents, which shall be city or county governments, stipulating the purpose for which the funds shall be expended. The regional emergency medical services and trauma care council shall use such funds to make available matching grants in an amount not to exceed fifty percent of the cost of the proposal for which the grant is made; provided, the department may waive or modify the matching requirement if it determines insufficient local funding exists and the public health and safety would be jeopardized if the proposal were not funded. Grants shall be made to any public or private nonprofit agency which, in the judgment of the regional emergency medical services and trauma care council, will best fulfill the purpose of the grant.
(2) Grants may be awarded for any of the following purposes:
(a) Establishment and initial development of an emergency medical services and trauma care system;
(b) Expansion and improvement of an emergency medical services and trauma care system;
(c) Purchase of equipment for the operation of an emergency medical services and trauma care system;
(d) Training and continuing education of emergency medical and trauma care personnel; and
(e) Department approved research and development activities pertaining to emergency medical services and trauma care.
(3) Any emergency medical services agency or trauma care provider which receives a grant shall stipulate that it will:
(a) Operate in accordance with applicable provisions and standards required under this chapter;
(b) Provide, without prior inquiry as to ability to pay, emergency medical and trauma care to all patients requiring such care; and
(c) Be consistent with applicable provisions of the regional emergency medical services and trauma care plan and the statewide emergency medical services and trauma care system plan.
[ 1990 c 269 s 16; 1987 c 214 s 8; 1979 ex.s. c 261 s 8. Formerly RCW 18.73.085.]

catchline: Disbursement of funds to regional emergency medical services and trauma care councils—Grants to nonprofit agencies—Purposes.


title: RCW 70.168.135

text:
The department shall establish by rule a grant program for designated trauma care services. The grants shall be made from the emergency medical services and trauma care system trust account and shall require regional matching funds. The trust account funds and regional match shall be in a seventy-five to twenty-five percent ratio.
[ 1997 c 331 s 1.]
Notes:
Effective date—1997 c 331: "Sections 1 through 8 of this act take effect January 1, 1998." [ 1997 c 331 s 11.]

catchline: Grant program for designated trauma care services—Rules.


title: RCW 70.168.140

text:
(1) No act or omission of any prehospital provider done or omitted in good faith while rendering emergency medical services in accordance with the approved regional plan shall impose any liability upon that provider.
(2) This section does not apply to the commission or omission of an act which is not within the field of the medical expertise of the provider.
(3) This section does not relieve a provider of any duty otherwise imposed by law.
(4) This section does not apply to any act or omission which constitutes gross negligence or willful or wanton misconduct.
(5) This section applies in addition to provisions already established in RCW 18.71.210.
[ 1990 c 269 s 26.]

catchline: Prehospital provider liability.


title: RCW 70.168.150

text:
(1) By January 1, 2011, the department shall endeavor to enhance and support an emergency cardiac and stroke care system through:
(a) Encouraging hospitals to voluntarily self-identify cardiac and stroke capabilities, indicating which level of cardiac and stroke service the facility provides. Hospital levels must be defined by the previous work of the emergency cardiac and stroke technical advisory committee and must follow the guiding principles and recommendations of the emergency cardiac and stroke work group report;
(b) Giving a hospital "deemed status" and designating it as a primary stroke center if it has received a certification of distinction for primary stroke centers issued by the nonprofit organization known as the joint commission. When available, a hospital shall demonstrate its cardiac or stroke level through external, national certifying organizations, including, but not limited to, primary stroke center certification by the joint commission; and
(c) Within the current authority of the department, adopting cardiac and stroke prehospital patient care protocols, patient care procedures, and triage tools, consistent with the guiding principles and recommendations of the emergency cardiac and stroke work group report.
(2) A hospital that voluntarily participates in the system:
(a) Shall participate in internal, as well as regional, quality improvement activities;
(b) Shall participate in a national, state, or local data collection system that measures cardiac and stroke system performance from patient onset of symptoms to treatment or intervention, and includes, at a minimum, the nationally recognized consensus measures for stroke; and
(c) May advertise participation in the system, but may not claim a verified certification level unless verified by an external, nationally recognized, evidence-based certifying body as provided in subsection (1)(b) of this section.
[ 2010 c 52 s 3.]
Notes:
Findings—Intent—2010 c 52: See note following RCW 70.168.015.

catchline: Emergency cardiac and stroke care system—Voluntary hospital participation.


title: RCW 70.168.160

text:
By December 1, 2012, the department shall share with the legislature the department's report, which was funded by the centers for disease control and prevention, concerning emergency cardiac and stroke care.
[ 2010 c 52 s 4.]
Notes:
Findings—Intent—2010 c 52: See note following RCW 70.168.015.

catchline: Report to the legislature.


title: RCW 70.168.170

text:
(1) The department, in consultation with the department of social and health services, shall convene a work group comprised of members of the steering committee and representatives of ambulance services, firefighters, mental health providers, and chemical dependency treatment programs. The work group shall establish alternative facility guidelines for the development of protocols, procedures, and applicable training appropriate to the level of emergency medical service provider for the appropriate transport of patients in need of immediate mental health or chemical dependency services.
(2) The alternative facility guidelines shall consider when transport to a mental health facility or chemical dependency treatment program is necessary as determined by:
(a) The presence of a medical emergency that requires immediate medical care;
(b) The severity of the mental health or substance use disorder needs of the patient;
(c) The training of emergency medical service personnel to respond to a patient experiencing emergency mental health or substance use disorders; and
(d) The risk the patient presents to the patient's self, the public, and the emergency medical service personnel.
(3) By July 1, 2016, the department shall make the guidelines available to all regional emergency medical services and trauma care councils for incorporation into regional emergency medical services and trauma care plans under RCW 70.168.100.
[ 2015 c 157 s 1.]

catchline: Ambulance services—Work group—Patient transportation—Mental health or chemical dependency services.


title: RCW 70.168.900

text:
This chapter shall be known and cited as the "statewide emergency medical services and trauma care system act."
[ 1990 c 269 s 2.]

catchline: Short title.


title: RCW 70.170.010

text:
(1) The legislature finds and declares that there is a need for health care information that helps the general public understand health care issues and how they can be better consumers and that is useful to purchasers, payers, and providers in making health care choices and negotiating payments. It is the purpose and intent of this chapter to establish a hospital data collection, storage, and retrieval system which supports these data needs and which also provides public officials and others engaged in the development of state health policy the information necessary for the analysis of health care issues.
(2) The legislature finds that rising health care costs and access to health care services are of vital concern to the people of this state. It is, therefore, essential that strategies be explored that moderate health care costs and promote access to health care services.
(3) The legislature further finds that access to health care is among the state's goals and the provision of such care should be among the purposes of health care providers and facilities. Therefore, the legislature intends that charity care requirements and related enforcement provisions for hospitals be explicitly established.
(4) The lack of reliable statistical information about the delivery of charity care is a particular concern that should be addressed. It is the purpose and intent of this chapter to require hospitals to provide, and report to the state, charity care to persons with acute care needs, and to have a state agency both monitor and report on the relative commitment of hospitals to the delivery of charity care services, as well as the relative commitment of public and private purchasers or payers to charity care funding.
[ 1989 1st ex.s. c 9 s 501.]

catchline: Intent.


title: RCW 70.170.020

text:
As used in this chapter:
(1) "Charity care" means medically necessary hospital health care rendered to indigent persons when third-party coverage, if any, has been exhausted, to the extent that the persons are unable to pay for the care or to pay deductibles or coinsurance amounts required by a third-party payer, as determined by the department.
(2) "Department" means department of health.
(3) "Hospital" means any health care institution which is required to qualify for a license under *RCW 70.41.020(8); or as a behavioral health hospital under chapter 71.12 RCW.
(4) "Indigent persons" are those patients or their guarantors who qualify for charity care pursuant to RCW 70.170.060(5) based on the federal poverty level, adjusted for family size, and who have exhausted any third-party coverage.
(5) "Secretary" means secretary of health.
(6) "Special studies" means studies which have not been funded through the department's biennial or other legislative appropriations.
(7) "Third-party coverage" means an obligation on the part of an insurance company, health care service contractor, health maintenance organization, group health plan, government program, tribal health benefits, or health care sharing ministry as defined in 26 U.S.C. Sec. 5000A to pay for the care of covered patients and services, and may include settlements, judgments, or awards actually received related to the negligent acts of others which have resulted in the medical condition for which the patient has received hospital health care service. The pendency of such settlements, judgments, or awards must not stay hospital obligations to consider an eligible patient for charity care.
[ 2024 c 121 s 28; 2022 c 197 s 1; 2018 c 263 s 1; 1995 c 269 s 2203; 1989 1st ex.s. c 9 s 502.]
Notes:
Reviser's note: *(1) RCW 70.41.020 was amended by 2025 c 182 s 4, changing subsection (8) to subsection (9).
(2) The definitions in this section have been alphabetized pursuant to RCW 1.08.015(2)(k).
Application—2022 c 197: "This act applies prospectively only to care provided on or after July 1, 2022. This act does not affect the ability of a patient who received care prior to July 1, 2022, to receive charity care under RCW 70.170.020 and 70.170.060 as the sections existed before that date." [ 2022 c 197 s 4.]
Effective date—2018 c 263: "This act takes effect October 1, 2018." [ 2018 c 263 s 3.]
Effective date—Part headings not law—Severability—1995 c 269: See notes following RCW 18.16.050.

catchline: Definitions.


title: RCW 70.170.050

text:
The department shall have the authority to respond to requests of others for special studies or analysis. The department may require such sponsors to pay any or all of the reasonable costs associated with such requests that might be approved, but in no event may costs directly associated with any such special study be charged against the funds generated by the assessment authorized under RCW 70.170.080.
[ 1989 1st ex.s. c 9 s 505.]

catchline: Requested studies—Costs.


title: RCW 70.170.060

text:
(1) No hospital or its medical staff shall adopt or maintain admission practices or policies which result in:
(a) A significant reduction in the proportion of patients who have no third-party coverage and who are unable to pay for hospital services;
(b) A significant reduction in the proportion of individuals admitted for inpatient hospital services for which payment is, or is likely to be, less than the anticipated charges for or costs of such services; or
(c) The refusal to admit patients who would be expected to require unusually costly or prolonged treatment for reasons other than those related to the appropriateness of the care available at the hospital.
(2) No hospital shall adopt or maintain practices or policies which would deny access to emergency care based on ability to pay. No hospital which maintains an emergency department shall transfer a patient with an emergency medical condition or who is in active labor unless the transfer is performed at the request of the patient or is due to the limited medical resources of the transferring hospital. Hospitals must make transfers to other hospitals in such circumstances and as promptly as dictated by the standard of care and follow reasonable procedures in making transfers to other hospitals including confirmation of acceptance of the transfer by the receiving hospital.
(3) The department shall develop definitions by rule, as appropriate, for subsection (1) of this section and, with reference to federal requirements, subsection (2) of this section. The department shall monitor hospital compliance with subsections (1) and (2) of this section. The department shall report individual instances of possible noncompliance to the state attorney general or the appropriate federal agency.
(4) The department shall establish and maintain by rule, consistent with the definition of charity care in RCW 70.170.020, the following:
(a) Uniform procedures, data requirements, and criteria for identifying patients receiving charity care; and
(b) A definition of residual bad debt including reasonable and uniform standards for collection procedures to be used in efforts to collect the unpaid portions of hospital charges that are the patient's responsibility.
(5) For the purpose of providing charity care, each hospital shall develop, implement, and maintain a policy which shall enable indigent persons access to charity care. The policy shall include procedures for identifying patients who may be eligible for health care coverage through medical assistance programs under chapter 74.09 RCW or the Washington health benefit exchange and actively assisting patients to apply for any available coverage. If a hospital determines that a patient or their guarantor is qualified for retroactive health care coverage through the medical assistance programs under chapter 74.09 RCW, a hospital shall assist the patient or guarantor with applying for such coverage. If a hospital determines that a patient or their guarantor qualifies for retroactive health care coverage through the medical assistance programs under chapter 74.09 RCW, a hospital is not obligated to provide charity care under this section to any patient or their guarantor if the patient or their guarantor fails to make reasonable efforts to cooperate with the hospital's efforts to assist them in applying for such coverage. Hospitals may not impose application procedures for charity care or for assistance with retroactive coverage applications which place an unreasonable burden upon the patient or guarantor, taking into account any physical, mental, intellectual, or sensory deficiencies, or language barriers which may hinder the responsible party's capability of complying with application procedures. It is an unreasonable burden to require a patient to apply for any state or federal program where the patient is obviously or categorically ineligible or has been deemed ineligible in the prior 12 months.
(a) At a minimum, a hospital owned or operated by a health system that owns or operates three or more acute hospitals licensed under chapter 70.41 RCW, an acute care hospital with over 300 licensed beds located in the most populous county in Washington, or an acute care hospital with over 200 licensed beds located in a county with at least 450,000 residents and located on Washington's southern border shall grant charity care per the following guidelines:
(i) All patients and their guarantors whose income is not more than 300 percent of the federal poverty level, adjusted for family size, shall be deemed charity care patients for the full amount of the patient responsibility portion of their hospital charges;
(ii) All patients and their guarantors whose income is between 301 and 350 percent of the federal poverty level, adjusted for family size, shall be entitled to a 75 percent discount for the full amount of the patient responsibility portion of their hospital charges, which may be reduced by amounts reasonably related to assets considered pursuant to (c) of this subsection;
(iii) All patients and their guarantors whose income is between 351 and 400 percent of the federal poverty level, adjusted for family size, shall be entitled to a 50 percent discount for the full amount of the patient responsibility portion of their hospital charges, which may be reduced by amounts reasonably related to assets considered pursuant to (c) of this subsection.
(b) At a minimum, a hospital not subject to (a) of this subsection shall grant charity care per the following guidelines:
(i) All patients and their guarantors whose income is not more than 200 percent of the federal poverty level, adjusted for family size, shall be deemed charity care patients for the full amount of the patient responsibility portion of their hospital charges;
(ii) All patients and their guarantors whose income is between 201 and 250 percent of the federal poverty level, adjusted for family size, shall be entitled to a 75 percent discount for the full amount of the patient responsibility portion of their hospital charges, which may be reduced by amounts reasonably related to assets considered pursuant to (c) of this subsection; and
(iii) All patients and their guarantors whose income is between 251 and 300 percent of the federal poverty level, adjusted for family size, shall be entitled to a 50 percent discount for the full amount of the patient responsibility portion of their hospital charges, which may be reduced by amounts reasonably related to assets considered pursuant to (c) of this subsection.
(c)(i) If a hospital considers the existence, availability, and value of assets in order to reduce the discount extended, it must establish and make publicly available a policy on asset considerations and corresponding discount reductions.
(ii) If a hospital considers assets, the following types of assets shall be excluded from consideration:
(A) The first $5,000 of monetary assets for an individual or $8,000 of monetary assets for a family of two, and $1,500 of monetary assets for each additional family member. The value of any asset that has a penalty for early withdrawal shall be the value of the asset after the penalty has been paid;
(B) Any equity in a primary residence;
(C) Retirement plans other than 401(k) plans;
(D) One motor vehicle and a second motor vehicle if it is necessary for employment or medical purposes;
(E) Any prepaid burial contract or burial plot; and
(F) Any life insurance policy with a face value of $10,000 or less.
(iii) In considering assets, a hospital may not impose procedures which place an unreasonable burden on the responsible party. Information requests from the hospital to the responsible party for the verification of assets shall be limited to that which is reasonably necessary and readily available to substantiate the responsible party's qualification for charity sponsorship and may not be used to discourage application for such sponsorship. Only those facts relevant to eligibility may be verified and duplicate forms of verification may not be demanded.
(A) In considering monetary assets, one current account statement shall be considered sufficient for a hospital to verify a patient's assets.
(B) In the event that no documentation for an asset is available, a hospital shall rely upon a written and signed statement from the responsible party.
(iv) Asset information obtained by the hospital in evaluating a patient for charity care eligibility shall not be used for collection activities.
(v) Nothing in this section prevents a hospital from considering assets as required by the centers for medicare and medicaid services related to medicare cost reporting.
(6) Each hospital shall post and prominently display notice of charity care availability. Notice must be posted in all languages spoken by more than ten percent of the population of the hospital service area. Notice must be displayed in at least the following locations:
(a) Areas where patients are admitted or registered;
(b) Emergency departments, if any; and
(c) Financial service or billing areas where accessible to patients.
(7) Current versions of the hospital's charity care policy, a plain language summary of the hospital's charity care policy, and the hospital's charity care application form must be available on the hospital's website. The summary and application form must be available in all languages spoken by more than ten percent of the population of the hospital service area.
(8)(a) All hospital billing statements and other written communications concerning billing or collection of a hospital bill by a hospital must include the following or a substantially similar statement prominently displayed on the first page of the statement in both English and the second most spoken language in the hospital's service area:
You may qualify for free care or a discount on your hospital bill, whether or not you have insurance. Please contact our financial assistance office at ...(website)... and ...(phone number)....
(b) Nothing in (a) of this subsection requires any hospital to alter any preprinted hospital billing statements existing as of October 1, 2018.
(9) Hospital obligations under federal and state laws to provide meaningful access for limited English proficiency and non-English-speaking patients apply to information regarding billing and charity care. Hospitals shall develop standardized training programs on the hospital's charity care policy and use of interpreter services, and provide regular training for appropriate staff, including the relevant and appropriate staff who perform functions relating to registration, admissions, or billing.
(10) Each hospital shall make every reasonable effort to determine:
(a) The existence or nonexistence of private or public sponsorship which might cover in full or part the charges for care rendered by the hospital to a patient;
(b) The annual family income of the patient as classified under federal poverty income guidelines as of the time the health care services were provided, or at the time of application for charity care if the application is made within two years of the time of service, the patient has been making good faith efforts towards payment of health care services rendered, and the patient demonstrates eligibility for charity care; and
(c) The eligibility of the patient for charity care as defined in this chapter and in accordance with hospital policy. An initial determination of sponsorship status shall precede collection efforts directed at the patient.
(11) At the hospital's discretion, a hospital may consider applications for charity care at any time, including any time there is a change in a patient's financial circumstances.
(12) The department shall monitor the distribution of charity care among hospitals, with reference to factors such as relative need for charity care in hospital service areas and trends in private and public health coverage. The department shall prepare reports that identify any problems in distribution which are in contradiction of the intent of this chapter. The report shall include an assessment of the effects of the provisions of this chapter on access to hospital and health care services, as well as an evaluation of the contribution of all purchasers of care to hospital charity care.
(13) The department shall issue a report on the subjects addressed in this section at least annually, with the first report due on July 1, 1990.
[ 2025 c 182 s 3; 2022 c 197 s 2; 2018 c 263 s 2; 1998 c 245 s 118; 1989 1st ex.s. c 9 s 506.]
Notes:
Findings—Effective date—2025 c 182: See notes following RCW 70.41.570.
Application—2022 c 197: See note following RCW 70.170.020.
Effective date—2018 c 263: See note following RCW 70.170.020.

catchline: Charity care—Prohibited and required hospital practices and policies—Rules—Notice of charity care availability—Department to monitor and report.


title: RCW 70.170.070

text:
(1) Every person who shall violate or knowingly aid and abet the violation of RCW * 70.170.060 (5) or (6), 70.170.080, or ** 70.170.100, or any valid orders or rules adopted pursuant to these sections, or who fails to perform any act which it is herein made his or her duty to perform, shall be guilty of a misdemeanor. Following official notice to the accused by the department of the existence of an alleged violation, each day of noncompliance upon which a violation occurs shall constitute a separate violation. Any person violating the provisions of this chapter may be enjoined from continuing such violation. The department has authority to levy civil penalties not exceeding one thousand dollars for violations of this chapter and determined pursuant to this section.
(2) Every person who shall violate or knowingly aid and abet the violation of RCW 70.170.060 (1) or (2), or any valid orders or rules adopted pursuant to such section, or who fails to perform any act which it is herein made his or her duty to perform, shall be subject to the following criminal and civil penalties:
(a) For any initial violations: The violating person shall be guilty of a misdemeanor, and the department may impose a civil penalty not to exceed one thousand dollars as determined pursuant to this section.
(b) For a subsequent violation of RCW 70.170.060 (1) or (2) within five years following a conviction: The violating person shall be guilty of a misdemeanor, and the department may impose a penalty not to exceed three thousand dollars as determined pursuant to this section.
(c) For a subsequent violation with intent to violate RCW 70.170.060 (1) or (2) within five years following a conviction: The criminal and civil penalties enumerated in (a) of this subsection; plus up to a three-year prohibition against the issuance of tax exempt bonds under the authority of the Washington health care facilities authority; and up to a three-year prohibition from applying for and receiving a certificate of need.
(d) For a violation of RCW 70.170.060 (1) or (2) within five years of a conviction under (c) of this subsection: The criminal and civil penalties and prohibition enumerated in (a) and (b) of this subsection; plus up to a one-year prohibition from participation in the state medical assistance or medical care services authorized under chapter 74.09 RCW.
(3) The provisions of chapter 34.05 RCW shall apply to all noncriminal actions undertaken by the department of health, the department of social and health services, and the Washington health care facilities authority pursuant to chapter 9, Laws of 1989 1st ex. sess.
[ 1989 1st ex.s. c 9 s 507.]
Notes:
Reviser's note: *(1) RCW 70.170.060 was amended by 2018 c 263 s 2, changing subsection (6) to subsection (10), effective October 1, 2018.
**(2) RCW 70.170.100 was repealed by 1995 c 265 s 27 and by 1995 c 267 s 12, effective July 1, 1995.

catchline: Penalties.


title: RCW 70.170.080

text:
The basic expenses for the hospital data collection and reporting activities of this chapter shall be financed by an assessment against hospitals of no more than four one-hundredths of one percent of each hospital's gross operating costs, to be levied and collected from and after that date, upon which the similar assessment levied under *chapter 70.39 RCW is terminated, for the provision of hospital services for its last fiscal year ending on or before June 30th of the preceding calendar year. Budgetary requirements in excess of that limit must be financed by a general fund appropriation by the legislature. All moneys collected under this section shall be deposited by the state treasurer in the hospital data collection account which is hereby created in the state treasury. The department may also charge, receive, and dispense funds or authorize any contractor or outside sponsor to charge for and reimburse the costs associated with special studies as specified in RCW 70.170.050.
During the 1993-1995 fiscal biennium, moneys in the hospital data collection account may be expended, pursuant to appropriation, for hospital data analysis and the administration of the health information program. During the 2025-2027 fiscal biennium, moneys in the hospital data collection account may be expended for operating costs of the charity care program.
Any amounts raised by the collection of assessments from hospitals provided for in this section which are not required to meet appropriations in the budget act for the current fiscal year shall be available to the department in succeeding years.
[ 2026 c 268 s 933; 1993 sp.s. c 24 s 925; 1991 sp.s. c 13 s 71; 1989 1st ex.s. c 9 s 508.]
Notes:
*Reviser's note: Chapter 70.39 RCW was repealed by 1982 c 223 s 10, effective June 30, 1990.
Effective date—2026 c 268: See note following RCW 28B.15.210.
Severability—Effective dates—1993 sp.s. c 24: See notes following RCW 28A.310.020.
Effective dates—1991 sp.s. c 13: See note following RCW 18.04.105.

catchline: Assessments—Costs.


title: RCW 70.170.090

text:
The department and any of its contractors or agents shall maintain the confidentiality of any information which may, in any manner, identify individual patients.
[ 1989 1st ex.s. c 9 s 509.]

catchline: Confidentiality.


title: RCW 70.170.150

text:
(1) The office of the insurance commissioner, in consultation with the Washington health benefit exchange, shall study and analyze how increasing eligibility for charity care impacts enrollment in health plans with high deductibles over a four-year time period.
(2) By November 1, 2026, the office of the insurance commissioner shall report to the health care committees of the legislature enrollment trends in health plans with high deductibles from January 1, 2023, through June 30, 2026. The one-time report shall include the number of individuals enrolled in high deductible plans for each year and by each county.
(3) This section expires January 1, 2027.
[ 2022 c 197 s 3.]
Notes:
Application—2022 c 197: See note following RCW 70.170.020.

catchline: Enrollment study—Report to legislature. (Expires January 1, 2027.)


title: RCW 70.175.010

text:
(1) The legislature declares that availability of health services to rural citizens is an issue on which a state policy is needed.
The legislature finds that changes in the demand for health care, in reimbursement polices [policies] of public and private purchasers, [and] in the economic and demographic conditions in rural areas threaten the availability of care services.
In addition, many factors inhibit needed changes in the delivery of health care services to rural areas which include inappropriate and outdated regulatory laws, aging and inefficient health care facilities, the absence of local planning and coordination of rural health care services, the lack of community understanding of the real costs and benefits of supporting rural hospitals, the lack of regional systems to assure access to care that cannot be provided in every community, and the absence of state health care policy objectives.
The legislature further finds that the creation of effective health care delivery systems that assure access to health care services provided in an affordable manner will depend on active local community involvement. It further finds that it is the duty of the state to create a regulatory environment and health care payment policy that promotes innovation at the local level to provide such care.
It further declares that it is the responsibility of the state to develop policy that provides direction to local communities with regard to such factors as a definition of health care services, identification of statewide health status outcomes, clarification of state, regional, [and] community responsibilities and interrelationships for assuring access to affordable health care and continued assurances that quality health care services are provided.
(2) The legislature further finds that many rural communities do not operate hospitals in a cost-efficient manner. The cost of operating the rural hospital often exceeds the revenues generated. Some of these hospitals face closure, which may result in the loss of health care services for the community. Many communities are struggling to retain health care services by operating a cost-efficient facility located in the community. Current regulatory laws do not provide for the facilities licensure option that is appropriate for rural areas. A major barrier to the development of an appropriate rural licensure model is federal medicare approval to guarantee reimbursement for the costs of providing care and operating the facility. Medicare certification typically elaborates upon state licensure requirements. Medicare approval of reimbursement is more likely if the state has developed legal criteria for a rural-appropriate health facility. Medicare has begun negotiations with other states facing similar problems to develop exceptions with the goal of allowing reimbursement of rural alternative health care facilities. It is in the best interests of rural citizens for Washington state to begin negotiations with the federal government with the objective of designing a medicare eligible rural health care facility structured to meet the health care needs of rural Washington and be eligible for federal and state financial support for its development and operation.
[ 1989 1st ex.s. c 9 s 701.]

catchline: Legislative findings.


title: RCW 70.175.020

text:
Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
(1) "Administrative structure" means a system of contracts or formal agreements between organizations and persons providing health services in an area that establishes the roles and responsibilities each will assume in providing the services of the rural health care facility.
(2) "Department" means the department of health.
(3) "Health care delivery system" means services and personnel involved in providing health care to a population in a geographic area.
(4) "Health care facility" means any land, structure, system, machinery, equipment, or other real or personal property or appurtenances useful for or associated with delivery of inpatient or outpatient health care service or support for such care or any combination thereof which is operated or undertaken in connection with a hospital, clinic, health maintenance organization, diagnostic or treatment center, extended care facility, or any facility providing or designed to provide therapeutic, convalescent or preventive health care services.
(5) "Health care system strategic plan" means a plan developed by the participant and includes identification of health care service needs of the participant, services and personnel necessary to meet health care service needs, identification of health status outcomes and outcome measures, identification of funding sources, and strategies to meet health care needs including measures of effectiveness.
(6) "Institutions of higher education" means educational institutions as defined in RCW 28B.10.016.
(7) "Local administrator" means an individual or organization representing the participant who may enter into legal agreements on behalf of the participant.
(8) "Participant" means communities, counties, and regions that serve as a health care catchment area where the project site is located.
(9) "Project" means the Washington rural health system project.
(10) "Project site" means a site selected to participate in the project.
(11) "Rural health care facility" means a facility, group, or other formal organization or arrangement of facilities, equipment, and personnel capable of providing or assuring availability of health services in a rural area. The services to be provided by the rural health care facility may be delivered in a single location or may be geographically dispersed in the community health service catchment area so long as they are organized under a common administrative structure or through a mechanism that provides appropriate referral, treatment, and follow-up.
(12) "Secretary" means the secretary of health.
[ 1989 1st ex.s. c 9 s 702.]


title: RCW 70.175.030

text:
(1) The department shall establish the Washington rural health system project to provide financial and technical assistance to participants. The goal of the project is to help assure access to affordable health care services to citizens in the rural areas of Washington state.
(2) Administrative costs necessary to implement this project shall be kept at a minimum to insure the maximum availability of funds for participants.
(3) The secretary may contract with third parties for services necessary to carry out activities to implement this chapter where this will promote economy, avoid duplication of effort, and make the best use of available expertise.
(4) The secretary may apply for, receive, and accept gifts and other payments, including property and service, from any governmental or other public or private entity or person, and may make arrangements as to the use of these receipts, including the undertaking of special studies and other projects related to the delivery of health care in rural areas.
(5) In designing and implementing the project the secretary shall consider the report of the Washington rural health care commission established under chapter 207, Laws of 1988. Nothing in this chapter requires the secretary to follow any specific recommendation contained in that report except as it may also be included in this chapter.
[ 1994 sp.s. c 9 s 806; 1989 1st ex.s. c 9 s 703.]
Notes:
Severability—Headings and captions not law—Effective date—1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.

catchline: Project established—Implementation.


title: RCW 70.175.040

text:
The department shall adopt rules consistent with this chapter to carry out the purpose of this chapter. All rules shall be adopted in accordance with chapter 34.05 RCW. All rules and procedures adopted by the department shall minimize paperwork and compliance requirements for participants and should not be complex in nature so as to serve as a barrier or disincentive for prospective participants applying for the project.
[ 1989 1st ex.s. c 9 s 704.]

catchline: Rules.


title: RCW 70.175.050

text:
The secretary shall have the following powers and duties:
(1) To design the project application and selection process, including a program to advertise the project to rural communities and encourage prospective applicants to apply. Project sites that receive seed grant funding may hire consultants and shall perform other activities necessary to meet participant requirements defined in this chapter. In considering selection of participants eligible for seed grant funding, the secretary should consider project sites where (a) existing access to health care is severely inadequate, (b) where a financially vulnerable health care facility is present, (c) where a financially vulnerable health care facility is present and an adjoining community in the same catchment area has a competing facility, or (d) where improvements in the delivery of primary care services, including preventive care services, is needed.
The department may obtain technical assistance support for project sites that are not selected to be funded sites. The secretary shall select these assisted project sites based upon merit and to the extent possible, based upon the desire to address specific health status outcomes;
(2) To design acceptable outcome measures which are based upon health status outcomes and are to be part of the community plan, to work with communities to set acceptable local outcome targets in the health care delivery system strategic plan, and to serve as a general resource to participants in the planning, administration, and evaluation of project sites;
(3) To assess and approve community strategic plans developed by participants, including an assessment of the technical and financial feasibility of implementing the plan and whether adequate local support for the plan is demonstrated;
(4) To define health care catchment areas, identify financially vulnerable health care facilities, and to identify rural populations which are not receiving adequate health care services;
(5) To identify existing private and public resources which may serve as eligible consultants, identify technical assistance resources for communities in the project, create a register of public and private technical resource services available and provide the register to participants. The secretary shall screen consultants to determine their qualifications prior to including them on the register;
(6) To work with other state agencies, institutions of higher education, and other public and private organizations to coordinate technical assistance services for participants;
(7) To administer available funds for community use while participating in the project and establish procedures to assure accountability in the use of seed grant funds by participants;
(8) To define data and other minimum requirements for adequate evaluation of projects and to develop and implement an overall monitoring and evaluation mechanism for the projects;
(9) To act as facilitator for multiple applicants and entrants to the project;
(10) To report to the appropriate legislative committees and others from time to time on the progress of the projects including the identification of statutory and regulatory barriers to successful completion of rural health care delivery goals and an ongoing evaluation of the project.
[ 1991 c 224 s 1; 1989 1st ex.s. c 9 s 705.]

catchline: Secretary's powers and duties.


title: RCW 70.175.060

text:
The duties and responsibilities of participating communities shall include:
(1) To involve major health care providers, businesses, public officials, and other community leaders in project design, administration, and oversight;
(2) To identify an individual or organization to serve as the local administrator of the project. The secretary may require the local administrator to maintain acceptable accountability of seed grant funding;
(3) To coordinate and avoid duplication of public health and other health care services;
(4) To assess and analyze community health care needs;
(5) To identify services and providers necessary to meet needs;
(6) To develop outcome measures to assess the long-term effectiveness of modifications initiated through the project;
(7) To write a health care delivery system strategic plan including to the extent possible, identification of outcome measures needed to achieve health status outcomes identified in the plan. New organizational structures created should integrate existing programs and activities of local health providers so as to maximize the efficient planning and delivery of health care by local providers and promote more accessible and affordable health care services to rural citizens. Participants should create health care delivery system strategic plans which promote health care services which the participant can financially sustain;
(8) To screen and contract with consultants for technical assistance if the project site was selected to receive funding and assistance is needed;
(9) To monitor and evaluate the project in an ongoing manner;
(10) To implement necessary changes as defined in the plans such as converting existing facilities, developing or modifying services, recruiting providers, or obtaining agreements with other communities to provide some or all health care services; and
(11) To provide data and comply with other requirements of the administrator that are intended to evaluate the effectiveness of the projects.
[ 1989 1st ex.s. c 9 s 706.]

catchline: Duties and responsibilities of participating communities.


title: RCW 70.175.070

text:
(1) The secretary may call upon other agencies of the state to provide available information to assist the secretary in meeting the responsibilities under this chapter. This information shall be supplied as promptly as circumstances permit.
(2) The secretary may call upon other state agencies including institutions of higher education as authorized under Title 28B RCW to identify and coordinate the delivery of technical assistance services to participants in meeting the responsibilities of this chapter. The state agencies and institutions of higher education shall cooperate and provide technical assistance to the secretary to the extent that current funding for these agencies and institutions of higher education permits.
[ 1989 1st ex.s. c 9 s 707.]

catchline: Cooperation of state agencies.


title: RCW 70.175.080

text:
In addition to the powers and duties specified in RCW 70.175.050 the secretary has the power to enter into contracts for the following functions and services:
(1) With public or private agencies, to assist the secretary in the secretary's duties to design or revise the health status outcomes, or to monitor or evaluate the performance of participants.
(2) With public or private agencies, to provide technical or professional assistance to project participants.
[ 1989 1st ex.s. c 9 s 708.]

catchline: Powers and duties of secretary—Contracting.


title: RCW 70.175.090

text:
(1) Participants are authorized to use funding granted to them by the secretary for the purpose of contracting for technical assistance services. Participants shall use only consultants identified by the secretary for consulting services unless the participant can show that an alternative consultant is qualified to provide technical assistance and is approved by the secretary. Adequate records shall be kept by the participant showing project site expenditures from grant moneys. Inappropriate use of grant funding shall be a gross misdemeanor.
(2) In providing a list of qualified consultants the secretary and the state shall not be held responsible for assuring qualifications of consultants and shall be held harmless for the actions of consultants. Furthermore, the secretary and the state shall not be held liable for the failure of participants to meet contractual obligations established in connection with project participation.
[ 1989 1st ex.s. c 9 s 709.]

catchline: Participants authorized to contract—Penalty—Secretary and state exempt from liability.


title: RCW 70.175.100

text:
(1) The department shall establish and adopt such standards and rules pertaining to the construction, maintenance, and operation of a rural health care facility and the scope of health care services, and rescind, amend, or modify the rules from time to time as necessary in the public interest. In developing the rules, the department shall consult with representatives of rural hospitals, community mental health centers, public health departments, community and migrant health clinics, and other providers of health care in rural communities. The department shall also consult with third-party payers, consumers, local officials, and others to ensure broad participation in defining regulatory standards and requirements that are appropriate for a rural health care facility.
(2) When developing the rural health care facility licensure rules, the department shall consider the report of the Washington rural health care commission established under chapter 207, Laws of 1988. Nothing in this chapter requires the department to follow any specific recommendation contained in that report except as it may also be included in this chapter.
(3) Upon developing rules, the department shall enter into negotiations with appropriate federal officials to seek medicare approval of the facility and financial participation of medicare and other federal programs in developing and operating the rural health care facility.
[ 1998 c 245 s 119; 1989 1st ex.s. c 9 s 710.]

catchline: Licensure—Rules.


title: RCW 70.175.110

text:
In developing the rural health care facility licensure regulations, the department shall:
(1) Minimize regulatory requirements to permit local flexibility and innovation in providing services;
(2) Promote the cost-efficient delivery of health care and other social services as is appropriate for the particular local community;
(3) Promote the delivery of services in a coordinated and nonduplicative manner;
(4) Maximize the use of existing health care facilities in the community;
(5) Permit regionalization of health care services when appropriate;
(6) Provide for linkages with hospitals, tertiary care centers, and other health care facilities to provide services not available in the facility; and
(7) Achieve health care outcomes defined by the community through a community planning process.
[ 1989 1st ex.s. c 9 s 711.]

catchline: Licensure—Rules—Duties of department.


title: RCW 70.175.120

text:
The rural health care facility is not considered a hospital for building occupancy purposes.
[ 1989 1st ex.s. c 9 s 712.]

catchline: Rural health care facility not a hospital.


title: RCW 70.175.130

text:
The department may develop and implement a rural health care plan and may approve hospital and rural health care facility requests to be designated as essential access community hospitals or rural primary care hospitals so that such facilities may form rural health networks to preserve health care services in rural areas and thereby be eligible for federal program funding and enhanced medicare reimbursement. The department may monitor any rural health care plan and designated facilities to assure continued compliance with the rural health care plan.
[ 1992 c 27 s 4; 1990 c 271 s 18.]

catchline: Rural health care plan.


title: RCW 70.175.140

text:
Any licensee or applicant desiring to make alterations or additions to its facilities or to construct new facilities may contact the department for consultative advice before commencing such alteration, addition, or new construction.
[ 1992 c 27 s 5.]

catchline: Consultative advice for licensees or applicants.


title: RCW 70.180.005

text:
The legislature finds that a health care access problem exists in rural areas of the state because rural health care providers are unable to leave the community for short-term periods of time to attend required continuing education training or for personal matters because their absence would leave the community without adequate medical care coverage. The lack of adequate medical coverage in geographically remote rural communities constitutes a threat to the health and safety of the people in those communities.
The legislature declares that it is in the public interest to recruit and maintain a pool of physicians, physician assistants, pharmacists, and *advanced registered nurse practitioners willing and able on short notice to practice in rural communities on a short-term basis to meet the medical needs of the community.
[ 1991 c 332 s 27; 1990 c 271 s 1.]
Notes:
*Reviser's note: The term "advanced registered nurse practitioner" was changed to "advanced practice registered nurse" by 2024 c 239 s 1, effective June 30, 2027.
Application to scope of practice—Captions not law—1991 c 332: See notes following RCW 18.130.010.

catchline: Finding—Health care professionals.


title: RCW 70.180.009

text:
The legislature finds that a shortage of physicians, nurses, pharmacists, and physician assistants exists in rural areas of the state. In addition, many education programs to train these health care providers do not include options for practical training experience in rural settings. As a result, many health care providers find their current training does not prepare them for the unique demands of rural practice.
The legislature declares that the availability of rural training opportunities as a part of professional medical, nursing, pharmacist, and physician assistant education would provide needed practical experience, serve to attract providers to rural areas, and help address the current shortage of these providers in rural Washington.
[ 1990 c 271 s 14.]

catchline: Finding—Rural training opportunities.


title: RCW 70.180.011

text:
Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
(1) "Department" means the department of health.
(2) "Rural areas" means a rural area in the state of Washington as identified by the department.
[ 1991 c 332 s 29.]
Notes:
Application to scope of practice—Captions not law—1991 c 332: See notes following RCW 18.130.010.

catchline: Definitions.