1. (1) The criteria in this section shall be used as guidelines when examining services to determine whether the service is considered a tertiary service.

2. (2) In determining whether a service is a tertiary service the department shall consider the degree to which the service meets the following criteria:

   1. (a) Whether the service is dependent on the skills and coordination of specialties and subspecialties. Including, but not limited to, physicians, nurses, therapists, social workers;
   2. (b) Whether the service requires immediate access to an acute care hospital;
   3. (c) Whether the service is characterized by relatively few providers;
   4. (d) Whether the service is broader than a procedure;
   5. (e) Whether the service has a low use rate;
   6. (f) Whether consensus supports or published research shows that sufficient volume is required to impact structure, process, and outcomes of care; and
   7. (g) Whether the service carries a significant risk or consequence.

3. (3) Periodically the department shall request review of proposed changes to the list of tertiary services identified in WAC 246-310-020. The periodic review shall be conducted as follows:

   1. (a) The department shall send notice to all persons who have sent the certificate of need program a written request to be notified of the annual review of tertiary services.

   2. (b) The notice shall contain the following:

      1. (i) Identification of the thirty-day period during which written comments may be received. This thirty-day period shall be called the comment period;
      2. (ii) The criteria listed in this section; and
      3. (iii) The name and address of the person in the department to whom written comments are to be addressed.
   3. (c) The written comments must address whether a service meets or partially meets the criteria in this section.
   4. (d) Within sixty days after the close of the comment period the department shall determine whether to propose any changes to the list of tertiary services in chapter 246-310 WAC. This sixty-day period shall be called the consideration period.
   5. (e) During the consideration period information may be exchanged between the department and persons proposing changes to the list of tertiary services in chapter 246-310 WAC.

4. (4) The department shall convene a technical work group at least every three years to do the following:

   1. (a) Review the criteria listed in this section to determine whether the criteria appropriately define a tertiary service; and
   2. (b) Propose any necessary changes to the list of tertiary services in WAC 246-310-020.

[Statutory Authority: Chapter 70.38 RCW. WSR 96-24-052, § 246-310-035, filed 11/27/96, effective 12/28/96. Statutory Authority: RCW 70.38.135 and 70.38.919. WSR 92-02-018 (Order 224), § 246-310-035, filed 12/23/91, effective 1/23/92.]