Chapter 246-329 WAC
Last Update: 7/15/25BIRTHING CENTERS
WAC Sections
| HTMLPDF | 246-329-005 | Scope and purpose. |
| HTMLPDF | 246-329-010 | Definitions. |
| HTMLPDF | 246-329-020 | Licensure. |
| HTMLPDF | 246-329-025 | Exemptions, alternative methods, and interpretations. |
| HTMLPDF | 246-329-030 | Governance. |
| HTMLPDF | 246-329-045 | Applicant or licensee rights and responsibilities. |
| HTMLPDF | 246-329-055 | Department responsibilities. |
| HTMLPDF | 246-329-065 | New construction—Major alterations. |
| HTMLPDF | 246-329-075 | Criminal history, disclosure, and background inquiries. |
| HTMLPDF | 246-329-085 | Client bill of rights. |
| HTMLPDF | 246-329-095 | Staffing. |
| HTMLPDF | 246-329-110 | Personnel policy and procedures and records. |
| HTMLPDF | 246-329-120 | Birth center policies and procedures. |
| HTMLPDF | 246-329-125 | Infection control. |
| HTMLPDF | 246-329-130 | Birth center equipment and supplies. |
| HTMLPDF | 246-329-140 | Patient records. |
| HTMLPDF | 246-329-150 | Pharmaceuticals. |
| HTMLPDF | 246-329-160 | Birth center—Physical environment. |
| HTMLPDF | 246-329-170 | Emergency preparedness. |
| HTMLPDF | 246-329-180 | Quality improvement. |
| HTMLPDF | 246-329-990 | Fees. |
DISPOSITION OF SECTIONS FORMERLY CODIFIED IN THIS TITLE
| 246-329-001 | Purpose. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-329-001, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.46.060. WSR 86-04-031 (Order 2338), § 248-29-001, filed 1/29/86. Statutory Authority: RCW 43.20.050. WSR 80-05-099 (Order 197), § 248-29-001, filed 5/2/80.] Repealed by WSR 97-20-101, filed 9/29/97, effective 10/30/97. Statutory Authority: RCW 43.70.040. |
| 246-329-035 | Criminal history, disclosure, and background inquiries. [Statutory Authority: RCW 43.43.830 through 43.43.842. WSR 93-16-030 (Order 381), § 246-329-035, filed 7/26/93, effective 8/26/93.] Repealed by WSR 07-07-075, filed 3/16/07, effective 4/16/07. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. |
| 246-329-040 | Personnel, clinical staff, and volunteers who work directly with clients. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-329-040, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.46.060. WSR 86-04-031 (Order 2338), § 248-29-040, filed 1/29/86. Statutory Authority: RCW 43.20.050. WSR 80-05-099 (Order 197), § 248-29-040, filed 5/2/80.] Repealed by WSR 07-07-075, filed 3/16/07, effective 4/16/07. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. |
| 246-329-050 | HIV/AIDS education and training. [Statutory Authority: RCW 18.46.060 and 70.24.310. WSR 92-02-018 (Order 224), § 246-329-050, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-329-050, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 70.24.310. WSR 89-21-038 (Order 3), § 248-29-045, filed 10/12/89, effective 11/12/89.] Repealed by WSR 07-07-075, filed 3/16/07, effective 4/16/07. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. |
| 246-329-060 | Birth center policies and procedures. [Statutory Authority: RCW 18.46.060. WSR 92-02-018 (Order 224), § 246-329-060, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-329-060, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.46.060. WSR 86-04-031 (Order 2338), § 248-29-050, filed 1/29/86; WSR 83-07-017 (Order 256), § 248-29-050, filed 3/10/83. Statutory Authority: RCW 43.20.050. WSR 82-06-011 (Order 226), § 248-29-050, filed 2/22/82; WSR 80-05-099 (Order 197), § 248-29-050, filed 5/2/80.] Repealed by WSR 07-07-075, filed 3/16/07, effective 4/16/07. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. |
| 246-329-070 | Birth center equipment and supplies. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-329-070, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.46.060. WSR 86-04-031 (Order 2338), § 248-29-060, filed 1/29/86. Statutory Authority: RCW 43.20.050. WSR 80-05-099 (Order 197), § 248-29-060, filed 5/2/80.] Repealed by WSR 07-07-075, filed 3/16/07, effective 4/16/07. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. |
| 246-329-080 | Records. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-329-080, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.46.060. WSR 86-04-031 (Order 2338), § 248-29-070, filed 1/29/86. Statutory Authority: RCW 43.20.050. WSR 80-05-099 (Order 197), § 248-29-070, filed 5/2/80.] Repealed by WSR 07-07-075, filed 3/16/07, effective 4/16/07. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. |
| 246-329-090 | Pharmaceuticals. [Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-329-090, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.46.060. WSR 86-04-031 (Order 2338), § 248-29-080, filed 1/29/86. Statutory Authority: RCW 43.20.050. WSR 80-05-099 (Order 197), § 248-29-080, filed 5/2/80.] Repealed by WSR 07-07-075, filed 3/16/07, effective 4/16/07. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. |
| 246-329-100 | Birth center—Physical environment. [Statutory Authority: RCW 18.46.060. WSR 92-02-018 (Order 224), § 246-329-100, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-329-100, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.46.060. WSR 86-04-031 (Order 2338), § 248-29-090, filed 1/29/86. Statutory Authority: RCW 43.20.050. WSR 80-05-099 (Order 197), § 248-29-090, filed 5/2/80.] Repealed by WSR 07-07-075, filed 3/16/07, effective 4/16/07. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. |
PDF246-329-005
Scope and purpose.
(1) These rules implement chapter 18.46 RCW which requires the department of health to set minimum health and safety standards for birthing centers.
(2) Applicants and licensees must meet the requirements of this chapter and other applicable state and local laws.
(3) This chapter does not apply to services provided by persons exempt from requirements of chapter 18.46 RCW.
(4) A birthing center may not provide services unless the birthing center is licensed under this chapter.
PDF246-329-010
Definitions.
For purposes of this chapter, the following words and phrases will have the following meanings unless the context clearly indicates otherwise:
(1) "Administration of drugs" means an act in which a single dose of a prescribed drug or biological is given to a patient by an authorized person in accordance with all laws and rules governing these acts. The complete act of administration entails removing an individual dose from a previously dispensed, properly labeled container, including a unit dose container, verifying it with the orders of a practitioner who is legally authorized to prescribe, giving the individual dose to the proper patient and properly recording the time and dose given.
(2) "Applicant" means a person or entity seeking licensure as a birthing center under this chapter.
(3) "Authenticated or authentication" means authorization of an entry in a record by means of a written or electronic signature which must include, minimally, first initial, last name, and title or unique identifier verifying accuracy of information.
(4) "Bathing facility" means a bathtub or shower.
(5) "Bathroom" means a room containing a toilet and a handwashing sink. A bathroom must provide privacy by way of walls or other provisions. A bathroom may or may not include a bathtub or shower. A bathroom that exists inside of a birthing room does not need an additional handwashing sink nor additional privacy walls.
(6) "Birthing center" or "birth center" means any health facility, not part of a hospital or in a hospital, that provides facilities and clinical staff to support a birth service to low-risk maternity clients and their newborns. This chapter does not apply to any hospital approved by the American College of Surgeons, American Osteopathic Association, or its successor. A birthing center is considered B occupancy according to state adopted building codes.
(7) "Birthing room" means a room designed, equipped, and arranged to provide for the care of a patient and their newborn and to accommodate their support people during the process of vaginal childbirth (the three stages of labor and recovery of both patient and newborn).
(8) "Birth service" means the intrapartum and immediate postpartum care provided for low-risk maternity clients, including newborn care during transition and stabilization.
(9) "Client" means a pregnant or postpartum patient, receiving care and services provided by a birth center during labor, birth, and immediate postpartum.
(10) "Clinical staff" means physicians and midwives, including contractors, appointed by the governing body or their representative to practice within the birth center and governed by rules and policies and procedures approved by the governing body.
(11) "Consultation" means the process used by the clinical staff of a birthing center who maintain primary management responsibilities for the client or newborn's care to seek the opinion of a licensed health care provider on clinical issues that are patient specific. The health care provider consulted must be qualified by training and experience in the specific patient need for which consultation is sought.
(12) "Contractor" means an individual who has a written contract with a birthing center licensee to provide birth services. The written contract must be approved by the governing body or their representative, and must include documentation of specific clinical privileges granted. Birth services provided by contractors in licensed birthing centers must meet requirements of this chapter, unless otherwise noted.
(13) "Department" means the Washington state department of health.
(14) "Emergency" means a medical emergency or injury requiring immediate medical or surgical intervention to prevent death or disability.
(15) "Emergency transfer" means the transfer of a client in an emergent situation to a facility that can manage obstetrical and neonatal emergencies beyond the scope of community birth, including the ability to perform cesarean delivery.
(16) "Governing body" means the person or persons responsible for establishing and approving the purposes and policies and procedures of the birthing center.
(17) "Hospital" means any institution, place, building, or agency providing accommodations, facilities, and services as defined in chapter 70.41 RCW.
(18) "Low-risk pregnancy" means a normal, uncomplicated prenatal course as determined by documentation of adequate prenatal care, and anticipation of a normal uncomplicated labor and birth, as defined by reasonable and generally accepted criteria of maternal and fetal health and adopted by the Commission for the Accreditation of Birth Centers (CABC) indicators of compliance with standards for birth centers, reference edition 2.3, effective September 15, 2023.
(20) "Newborn" means a baby delivered by the pregnant client who is admitted to the birth center. Newborns are admitted to the birth center at delivery and receive care by the clinical staff at the birth center until discharge.
(21) "New construction" means any of the following:
(a) New buildings to be used as a birth center;
(b) Addition or additions to an existing building or buildings to be used as a birthing center;
(c) Conversion of existing buildings or portions thereof for use as a birthing center;
(d) Alterations or modifications other than minor alterations. "Minor alterations" means any structural or physical modification within an existing birth center which does not change the approved use of a room or an area. Minor alterations performed under this definition do not require prior review of the department; however, this does not constitute a release from other applicable requirements;
(e) Changes in the approved use of rooms or areas of the birth center.
(22) "Patient" means a client or newborn who is admitted to the birth center and under the care of the clinical staff.
(23) "Person" means any individual, firm, partnership, corporation, company, association, or joint stock association, and the legal successor thereof.
(24) "Personnel" means individuals employed by the birth center, contractors of the birth center, students and volunteers.
(25) "Physician" means a person licensed under chapter 18.71 RCW, "Physicians," and rules adopted under chapter 246-919 WAC or chapter 18.57 RCW, "Osteopathy—Osteopathic medicine and surgery," and rules adopted under chapter 246-853 WAC.
(26) "Referral" means the process by which the clinical staff of a birthing center directs the patient to a health care provider for management of a particular problem or aspect of the patient's care.
(27) "Registered nurse" means a person licensed under chapter 18.79 RCW, and rules adopted under chapter 246-840 WAC.
(28) "Recovery" means that period or duration of time starting at birth and ending with discharge of a client or newborn from the birth center.
(29) "Support person" means the individual or individuals selected or chosen by the client to provide emotional support and assistance during the process of labor and childbirth.
(30) "Transfer of care" means the process by which the clinical staff of a birthing center directs the client or newborn to a physician or other licensed health care provider for complete management of the client or newborn's care.
(31) "Volunteer" means an individual who is an unpaid worker in the birth center, other than a support person.
[Statutory Authority: RCW 18.46.060 and 43.70.250. WSR 25-15-078, s 246-329-010, filed 7/15/25, effective 8/15/25. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. WSR 07-07-075, § 246-329-010, filed 3/16/07, effective 4/16/07. Statutory Authority: RCW 18.46.060. WSR 92-02-018 (Order 224), § 246-329-010, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-329-010, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.46.060. WSR 86-04-031 (Order 2338), § 248-29-010, filed 1/29/86. Statutory Authority: RCW 43.20.050. WSR 80-05-099 (Order 197), § 248-29-010, filed 5/2/80.]
PDF246-329-020
Licensure.
A person must possess a current birth center license issued by the department before advertising, operating, managing, conducting, opening or maintaining a birthing center unless exempt under chapter 18.46 RCW. A birth center applicant working towards licensure may begin advertising via website or other means provided that language clearly communicates that the center is not currently licensed.
(1) Application for license. An applicant for initial licensure of a birthing center must:
(a) Submit a completed application on forms provided by the department;
(b) Submit disclosure statements and criminal history background checks no older than three months preceding the application date for the administrator, owner and director of services in accordance with RCW 43.43.830 through 43.43.845;
(c) Submit the following information:
(i) Name of managing personnel, officers, administrator, director of services, and partners or individuals owning 10 percent or more of the applicant's voting stock;
(ii) A description of the organizational structure;
(iii) A copy of the current business license(s);
(d) Submit evidence of completion of the department's construction review process;
(e) Submit evidence of compliance with local codes and ordinances;
(f) Submit evidence of approval of the state fire marshal as required per RCW 18.46.110;
(g) Submit evidence that a certificate of occupancy by the local building official has been approved and issued;
(h) Submit other information as required by the department;
(i) Submit fees as specified in WAC 246-329-990;
(j) Develop and approve policies and procedures addressing the content of this chapter; and
(k) Meet the requirements of this chapter as determined by an initial survey conducted by the department.
(2) License renewal.
(a) A license, unless suspended or revoked, must be renewed annually.
Applications for renewal must be on forms provided by the department and must be filed with the department not less than 30 days prior to expiration and must also include disclosure statements and criminal history background checks no older than three months preceding the renewal date for the administrator, owner, and director of services when these individuals are new to the birth center since initial licensure or last renewal, in accordance with RCW 43.43.830 through 43.43.845.
(b) The department may inspect and investigate each birthing center every 24 months or as needed to determine compliance with these rules and chapter 18.46 RCW.
(c) Each license must be issued only for the premises and persons named. Licenses must be transferable or assignable only with written approval by the department.
(d) Licenses must be posted in a conspicuous place on the licensed premises.
(3) Change of ownership. At least 30 days prior to changing ownership of a birthing center:
(a) The licensee must submit in writing to the department:
(i) The full name, address and phone number of the current and prospective owner;
(ii) The name, address, and phone number of the currently licensed birthing center and the name under which the prospective agency will operate; and
(iii) Date of the proposed change of ownership;
(b) The prospective new owner must submit:
(i) Information listed in subsection (1)(b) and (c) of this section; and
(ii) The change of ownership fee specified in WAC 246-329-990.
(4) The department may conduct a survey after a change of ownership approval to assess the new ownership's delivery of care to patients. The decision to conduct a survey would be based on department surveys, complaint investigations, and enforcement actions associated with the new owner(s).
[Statutory Authority: RCW 18.46.060 and 43.70.250. WSR 25-15-078, s 246-329-020, filed 7/15/25, effective 8/15/25. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. WSR 07-07-075, § 246-329-020, filed 3/16/07, effective 4/16/07. Statutory Authority: RCW 18.46.060 and 34.05.220. WSR 92-02-018 (Order 224), § 246-329-020, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-329-020, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 34.05 RCW, RCW 34.05.220 (1)(a) and 18.46.060. WSR 90-06-019 (Order 039), § 248-29-020, filed 2/28/90, effective 3/1/90. Statutory Authority: RCW 18.46.060. WSR 86-04-031 (Order 2338), § 248-29-020, filed 1/29/86; WSR 83-07-016 (Order 255), § 248-29-020, filed 3/10/83. Statutory Authority: RCW 43.20.050. WSR 80-05-099 (Order 197), § 248-29-020, filed 5/2/80.]
PDF246-329-025
Exemptions, alternative methods, and interpretations.
The purpose of this section is to provide birth centers a mechanism to request an interpretation, exemption, or approval to use an alternative method. This chapter is not intended to prevent use of any systems, materials, alternate design, or methods of construction as alternatives to those prescribed by these rules.
(1) A birth center requesting exemption from this chapter must submit a written request to the department asking for an exemption. The request must specify the section or sections, explain the reason for the exemption and, when appropriate, include supporting documentation.
(2) A birth center requesting approval for use of alternative materials, design, and methods must submit a written request to the department asking for approval to use an alternative. The request must explain the reason(s) for the use of an alternative and must be supported by technical documentation.
(3) The department may:
(a) Exempt a birth center from complying with portions of this chapter when:
(i) The exemption is not contrary to the intent of chapter 18.46 RCW and the requirements of these rules.
(ii) After review and consideration, the department determines the exemption will not:
(A) Negate the purpose and intent of these rules;
(B) Place the safety or health of the patients in the birth center in jeopardy;
(C) Lessen any fire and life safety or infection control provision of other codes or regulations; and
(D) Affect any structural integrity of the building;
(b) Approve the use of alternative materials, designs, and methods when:
(i) The birth center complies with subsection (2) of this section; and
(ii) After review and consideration, such alternative:
(A) Meets the intent and purpose of these rules; and
(B) Is at least equivalent to the methods prescribed in these rules.
(4) A birth center requesting an interpretation of rule contained in this chapter must submit a written request to the department. The request must specify the section or sections for which an interpretation is needed and details of the circumstances to which the rule is being applied. The birth center must provide any other information the department deems necessary.
(5) The department will, in response to a written request, send a written interpretation of a rule or regulation within 30 calendar days after the department has received complete information relevant to the requested interpretation.
(6) The birthing center must keep a copy of each exemption, alternative method, or interpretation issued under this section and have them available for department surveyors at all times.
PDF246-329-030
Governance.
The purpose of this section is to provide organizational guidance and oversight and to ensure resources and staff to support safe and adequate patient care.
(1) The birth center must have a governing body.
(2) The governing body must be responsible for providing personnel, facilities, equipment, supplies, and special services to meet the needs of the patients.
(3) The governing body must adopt policies for the care of patients within or on the premises of the birth center. Policies must be reviewed, at minimum, annually.
(4) The governing body must appoint an administrator or director responsible for implementing the policies adopted by the governing body.
(5) The governing body must establish and maintain a current written organizational plan which includes all positions and delineates responsibilities, authority, and relationship of positions within the birth center.
(6) The governing body must have the authority and responsibility for appointments and reappointments of clinical staff, approval of written contracts and appointment of contractors, approval of clinical bylaws and to ensure that only members of the clinical staff admit clients to the birth center.
(a) Each birth center must utilize consultation and appropriate clinical services as defined in WAC 246-329-095(2).
(b) Each physician and midwife, including contractors, appointed to the clinical staff must provide evidence of current licensure in the state of Washington.
(c) Members of the clinical staff must develop and adopt bylaws, policies, and procedures subject to the approval of the governing body including requirements for clinical staff membership; delineation of clinical privileges and the organization of clinical staff.
(7) The governing body must adopt policies for the delegation of responsibilities to staff including which responsibilities can and cannot be delegated and which staff are and are not appropriate for specific responsibilities.
(8) The governing body must be responsible for assuring a quality improvement program is implemented according to WAC 246-329-180.
(9) The governing body must be responsible for the legal and financial management of the birth center.
[Statutory Authority: RCW 18.46.060 and 43.70.250. WSR 25-15-078, s 246-329-030, filed 7/15/25, effective 8/15/25. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. WSR 07-07-075, § 246-329-030, filed 3/16/07, effective 4/16/07. Statutory Authority: RCW 18.46.060. WSR 92-02-018 (Order 224), § 246-329-030, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-329-030, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.46.060. WSR 86-04-031 (Order 2338), § 248-29-030, filed 1/29/86. Statutory Authority: RCW 43.20.050. WSR 80-05-099 (Order 197), § 248-29-030, filed 5/2/80.]
PDF246-329-045
Applicant or licensee rights and responsibilities.
This section describes the applicant or licensee's responsibilities in the fulfillment of the requirements of this chapter.
(1) An applicant or licensee must:
(a) Comply with chapter 18.46 RCW and this chapter;
(b) Establish, implement and periodically review all policies and procedures which address the contents of this chapter;
(c) Display the license issued by the department in an area accessible to the public;
(d) Notify the department in writing:
(i) Within 30 days of changes of an administrator, owner or the director of services;
(ii) Thirty or more days before ceasing operations;
(e) Cooperate with the department during surveys which may include reviewing licensee and client records and conducting client interviews with client consent;
(f) Respond to a statement of deficiencies by submitting to the department:
(i) A written plan of correction, within 10 working days of receipt. The applicant or licensee must complete all corrections within 60 days after the survey exit date, unless otherwise specified by the department; and
(ii) A progress report, when required, describing corrections made and ongoing monitoring actions, within 90 days after the survey exit date, unless the department specifies another date.
(2) An applicant or licensee may:
(a) Discuss findings observed during a survey with the surveyor; and
(b) Discuss the statement of deficiencies with the department's manager.
(3)(a) A birthing center must report adverse health events to the department in accordance with chapter 70.56 RCW.
(b) A birthing center must comply with the reporting requirements under chapter 246-302 WAC. Reporting requirements under chapter 246-302 WAC do not relieve a birth center from complying with other applicable reporting or notification requirements of this chapter or those requirements relating to law enforcement or professional regulatory agencies.
(4) An applicant or licensee has the right to respond to and contest a statement of charges according to the following provisions:
(a) RCW 43.70.115, department of health authority for license approval, denial, restriction, conditioning, modification, suspension and revocation;
(b) Chapter 34.05 RCW, the Administrative Procedure Act; and
(c) Chapter 246-10 WAC, Adjudicative proceedings.
[Statutory Authority: RCW 18.46.060 and 43.70.250. WSR 25-15-078, s 246-329-045, filed 7/15/25, effective 8/15/25. Statutory Authority: Chapter 70.56 RCW. WSR 12-16-057, § 246-329-045, filed 7/30/12, effective 10/1/12. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. WSR 07-07-075, § 246-329-045, filed 3/16/07, effective 4/16/07.]
PDF246-329-055
Department responsibilities.
This section describes the department's responsibilities in the fulfillment of the requirements of this chapter:
(1) The department may, in accordance with chapter 18.46 RCW:
(a) Issue an initial license for 12 months following submission of a completed application and appropriate fee, and following a survey that documents the applicant meets all the requirements of this chapter;
(b) Issue a renewal license for the 12-month period following submission of a completed application and appropriate fee;
(c) Issue a license for change of ownership to the new licensee for the remainder of the current license period following submission of the required information and appropriate fee, under WAC 246-329-990.
(2) The department may:
(a) Conduct surveys and investigations every 24 months or as needed to determine compliance with chapter 18.46 RCW and this chapter. Surveys and investigations may be announced or unannounced;
(b) Investigate any person suspected of:
(i) Advertising, operating, managing, conducting, opening or maintaining a birthing center without a license unless exempt from licensure under chapter 18.46 RCW; or
(ii) Survey a licensee at anytime if the department has reason to believe the licensee is providing unsafe, insufficient, inadequate or inappropriate care;
(c) Investigate allegations of noncompliance with RCW 43.43.830 through 43.43.845, when necessary, in consultation with law enforcement personnel;
(d) Require licensees to complete additional disclosure statements and background inquiries for an individual associated with the licensee or having direct contact with children under 16 years of age, people with developmental disabilities, or vulnerable adults if the department has reason to believe that offenses specified under RCW 43.43.830 have occurred since completion of the previous disclosure statement and criminal background inquiry; and
(e) Issue a statement of deficiencies following a survey which identifies noncompliance with chapter 18.46 RCW and this chapter.
(3) The department may deny, suspend, or revoke a license if the applicant or licensee fails or refuses to comply with the requirements of chapter 18.46 RCW and these rules. The department's notice of denial, suspension, modification, or revocation of a license must be consistent with RCW 43.70.115. An applicant or license holder has the right to an adjudicative proceeding to contest the decision.
(4) The department may prepare and serve upon the licensee or applicant at the earliest practical time a statement of charges following a survey which identifies noncompliance with chapter 18.46 RCW and this chapter. The statement of charges must include a notice that the licensee or applicant may request a hearing to contest the charges.
PDF246-329-065
New construction—Major alterations.
The purpose of this section is to provide minimum standards for a safe and efficient patient care environment consistent with other rules. The rules are intended to allow flexibility in achieving desired outcomes and enable birth centers to respond to changes in technologies and health care innovations.
(1) When a licensee or applicant is contemplating new construction or major alteration, the licensee or applicant must:
(a) Under chapters 70.40 RCW and 246-329 WAC, submit an application and construction documents to the department's construction review services program for all new construction and major alterations, as defined in WAC 246-329-010. In addition to the application and construction documents, the construction review services program may require documentation of approval from local zoning commissions, fire departments, and building departments, if applicable;
(b) Respond in writing when the department requests additional or corrected construction documents;
(c) Not begin construction until the construction documents are approved by the local jurisdictions and same local jurisdictions have issued any required permits;
(d) Complete construction consistent with the final "department approved" documents;
(e) Notify the department in writing when construction is completed; and
(f) Submit to the department a copy of the local jurisdictions' certificate of occupancy.
(2) A birthing center applicant or licensee must, through its design, construction and necessary permits demonstrate compliance with the following codes and local jurisdiction standards:
(a) The state building code as adopted by the state building code council.
(b) Accepted Procedure and Practice in Cross-contamination Control, Pacific Northwest Edition, 9th Edition, American Waterworks Association; and
(c) If planning on caring for patients with mycobacterium tuberculosis, Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health Care Settings, 2005. Morbidity and Mortality Weekly Report (MMWR), Volume 54, December 30, 2005.
PDF246-329-075
Criminal history, disclosure, and background inquiries.
The purpose of this section is to ensure criminal history background inquiries are conducted for any employee or prospective employee who has or will have unsupervised access to children, vulnerable adults, and individuals with developmental disabilities.
(1) A birthing center applicant or licensee must establish and implement policies and procedures regarding Washington state patrol criminal background inquiries and disclosure statements under RCW 43.43.830 through 43.43.845 for the administrator, owner, director of services and personnel, contractors, volunteers, students, and any other individual associated with the licensee having direct contact with children under 16 years of age, individuals with developmental disabilities, or vulnerable adults.
(2) The department may require licensees to complete additional disclosure statements or background inquiries for a person associated with the licensed facility having direct contact with vulnerable adults if the department has reason to believe that offenses specified under RCW 43.43.830 have occurred since completion of the previous disclosure statement or background inquiry.
PDF246-329-085
Client bill of rights.
The purpose of this section is to improve patient outcomes by ensuring birthing centers inform clients of specific rights.
The birthing center at the time of registration, including clients of contractors, must provide each client with an electronic or written bill of rights. The bill of rights is part of the informed consent process in WAC 246-329-120(2), affirming each client's rights to:
(1) A listing of the services provided by the birth center;
(2) Be informed of the policies and procedures for admission and discharge;
(3) Be informed of the definition of a low-risk pregnancy and the benefits and risks of out-of-hospital labor and birth;
(4) Be informed of the eligibility criteria for birth center services;
(5) Be informed of the policies and procedures for clients who choose hospital transfer during their admission to the birth center;
(6) Be informed of the policies and procedures for emergency and nonemergency care in the event of complications to client and newborn;
(7) Be informed that unexpected neonatal emergencies requiring complex resuscitation are rare, but can occur, and the birthing center staff are prepared to provide initial steps of newborn resuscitation until the newborn has been transported and discharged to another provider for additional medical care;
(8) Participate in decisions relating to the plan for management of care including informed consent, informed refusal, and reassessment of these plans as conditions change;
(9) Be informed of the policies and procedures for consultation, referral, transfer of care and transport of a client or newborn to a hospital when additional care is necessary;
(10) Be informed of the process for submitting and addressing complaints;
(11) Submit complaints without retaliation and to have the complaint addressed by the licensee;
(12) Be informed of the state complaint hotline number;
(13) Be treated with courtesy, dignity, respect, privacy, and freedom from abuse and discrimination;
(14) Privacy of personal information and confidentiality of health care records;
(15) Be cared for by properly trained personnel, contractors, students and volunteers and be informed of the qualifications of clinical staff, consultants and related services and institutions;
(16) A fully itemized billing statement upon request, including the date of each service and the charge. Estimated billing statements will be provided within five business days after the request. Finalized billing statements will be provided after third party processing has been completed;
(17) Be informed about advanced directives and the birth center's scope of responsibility;
(18) Be informed of the liability insurance coverage of practitioners on request; and
(19) Be informed that newborns must be secured in an appropriate motor vehicle restraint system before being discharged from the facility.
PDF246-329-095
Staffing.
The purpose of the staffing section is to ensure the birth center provides competent staff consistent with the scope of services.
(1) The birth center must have sufficient, qualified personnel and clinical staff to provide the services needed by patients and for safe maintenance and operation of the birth center.
(2) The birth center must develop and implement policies and procedures for consultation, referral, transfer of care, emergency transfer and transport of a newborn to a newborn nursery or neonatal intensive care nursery, and emergency transfer or transport of a client to an appropriate obstetrical department, patient care area or hospital when additional care is necessary.
(3) The birth center must:
(a) Employ, contract or use appropriately trained personnel and clinical staff; and
(b) Ensure clinical staff or personnel have evidence of current training in neonatal and adult resuscitation.
(c) Ensure a physician or midwife is present at each birth. A second person who is a qualified personnel, student, or clinical staff member with evidence of current training in neonatal and adult resuscitation skills must be immediately available in the birthing center during each birth.
(d) Ensure 24-hour coverage, including the provision that appropriate, qualified personnel or clinical staff must be present in the birth center at all times when clients are present.
PDF246-329-110
Personnel policy and procedures and records.
The purpose of this section is to ensure the birth center provides direction and standards in the employment, contracting and recording of personnel procedures.
(1) A birthing center applicant or licensee must establish and implement policies and procedures which include, but are not limited to:
(a) Employment criteria regarding discrimination with chapter 49.60 RCW;
(b) Job descriptions for employees, contractor agreements, volunteer responsibility statements and agreements with students commensurate with responsibilities and consistent with health care professional credentialing and scope of practice as defined in relevant practice acts and associated rules;
(c) Verification of clinical staff credentials;
(d) Verification of appointment letters for privileged staff which delineates clinical privileges;
(e) Orientation to current birth center policies and procedures and verification of skills or training for all clinical staff;
(f) Current neonatal and adult cardiopulmonary resuscitation training consistent with birth center policies and procedures and community standards for all clinical staff;
(g) Performance evaluations of all personnel, including evaluations of contractor and student agreements to be conducted per birth center's policy and procedure;
(h) Washington state patrol criminal background inquiries and disclosure statements under RCW 43.43.830 through 43.43.845 for the administrator, owner, director of services and personnel, contractors, volunteers, students, and any other individual associated with the licensee who has direct contact with children under 16 years of age, people with developmental disabilities or vulnerable adults;
(i) Infection control training which includes, but is not limited to, blood borne pathogens and universal precautions; and
(j) Annual emergency clinical skills training.
(2) The licensee maintain records on all employees, contractors, students, and volunteers to include the following information:
(a) Documentation of the items stated above in subsection (1)(b) through (j) of this section; and
(b) Evidence of communicable disease testing as required by local health authorities and per birth center policy and procedures and must include, at a minimum, documented evidence of tuberculin (TB) screening as required in subsection (1)(i) of this section and documented evidence of Hepatitis B vaccination being provided or offered according to chapter 296-823 WAC.
[Statutory Authority: RCW 18.46.060 and 43.70.250. WSR 25-15-078, s 246-329-110, filed 7/15/25, effective 8/15/25. Statutory Authority: RCW 18.19.050, 18.29.130, 18.29.210, 18.34.120, 18.46.060, 18.55.095, 18.84.040, 18.88B.060, 18.89.050, 18.130.050, 18.138.070, 18.155.040, 18.200.050, 18.205.060, 18.215.040, 18.230.040, 18.240.050, 18.250.020, 18.290.020, 18.360.030, 18.360.070, 70.41.030, 70.230.020, 71.12.670, and 18.108.085. WSR 21-02-002, § 246-329-110, filed 12/23/20, effective 1/23/21. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. WSR 07-07-075, § 246-329-110, filed 3/16/07, effective 4/16/07.]
PDF246-329-120
Birth center policies and procedures.
The purpose of this section is to ensure the birth center is able to provide safe and appropriate care to the patients of the birth center.
(1) An applicant or licensee must establish and implement policies and procedures which include, but are not limited to:
(a) Definition of a low-risk client who is eligible for birth services offered by the birth center. An applicant or licensee wanting to use a more recent version of the CABC indicators for compliance for the purpose of defining a low-risk client may submit an alternative method request following the process in WAC 246-329-025.
(b) Identification and transfer of clients and newborns who, during the course of labor or recovery, are determined to be ineligible for continued care in the birth center.
(c) Consultation, referral and transfer of care for client and newborn, including emergency transfer and transport of a newborn to a newborn nursery or neonatal intensive care nursery, and emergency transfer and transport of a client to an appropriate obstetrical department, patient care area, or hospital when additional care is necessary.
(d) Transfer and discharge of clients and newborns.
(e) Protocol for intermittent auscultation to monitor fetal status during labor.
(f) Actions to be taken upon death of a patient.
(g) Protocol for use of inhaled nitrous gas as an analgesic. Protocol must include, at minimum, the following:
(i) A process for establishing staff competency in nitrous oxide use prior to client self-administration;
(ii) Nitrous oxide being administered with oxygen by a member of the clinical staff. The maximum concentration of nitrous oxide is limited to 50 percent;
(iii) The client must always self-administer the nitrous oxide (the laboring person holds the mask or mouthpiece without any assistance from staff);
(iv) A clinical staff member is responsible for the counseling and education of the patient on nitrous oxide therapy and the setup and preparation of the nitrous oxide delivery system. These responsibilities cannot be delegated to other birth center personnel;
(v) Birth centers that offer nitrous oxide for labor analgesia must meet the equipment requirements in WAC 246-329-130 (1)(c).
(h) Birth centers that do not offer inhaled nitrous gas are not required to establish the policies, procedures, and protocols in (g) of this subsection.
(2) Clients must receive and sign written informed consent which must be obtained prior to admission and must include, but is not limited to:
(a) Explanation of the birth services offered and potential risks;
(b) Eligibility requirements for the admission to the birth center;
(c) Client bill of rights according to WAC 246-329-085;
(d) Explanation of transfer of care and emergency transfer and transport;
(e) Notification and recommendation to acquire peripartum services and whether those services are available at the birth center, including:
(i) Newborn metabolic and heart disease screening recommendations per chapters 70.83 RCW and 246-650 WAC.
(ii) Newborn hearing screening.
(iii) Prophylactic treatment of the eyes of the newborn in accordance with WAC 246-100-202.
(iv) Vitamin K injection for the newborn.
(v) Bilirubin screening for the newborn.
(vi) Medications for GBS prophylaxis.
(vii) Prophylactic administration of RhIG (immune globulin) within 72 hours of delivery for an Rh negative mother whose newborn(s) are Rh positive.
(viii) MMR vaccination for nonimmune newly postpartum clients.
(3) The birth center must provide or ensure:
(a) Reporting of patient/client abuse and neglect according to chapter 74.34 RCW.
(b) Plans for service delivery when natural or man-made emergencies occur that prevent normal clinical operation.
(c) Waived laboratory tests, if applicable, including the procurement of a medical test site waiver under chapter 246-338 WAC.
(d) Privileged clinical staff, employed or contracted, who agree to execute the following responsibilities:
(i) Education of clients, family and support persons in childbirth and newborn care.
(ii) Plans for immediate and long-term follow-up of clients and newborns after discharge from the birth center.
(iii) Registration of birth and reporting of complications and anomalies, including sentinel birth defect reporting under chapter 70.58 RCW.
(iv) Prophylactic treatment of the eyes of the newborn in accordance with WAC 246-100-202 (1)(e).
(v) Collection of a newborn screening blood specimen, or signed refusal, and submission to the department's newborn screening program under the requirements of WAC 246-650-020.
(vi) For HIV positive patients, appropriate testing, treatment, and risk assessment.
(vii) Intrapartum intravenous antibiotics for Group B Strep positive clients per the CDC protocol.
(viii) For Hepatitis B positive clients, HBIG and Hepatitis B immunization for the newborn.
(ix) Authorization and administration of medications, legend drugs and devices per appropriate health profession rules.
(x) Actions to address patient communication needs.
(xi) Emergency medical care of patient.
(xii) Reporting of patient/client abuse and neglect according to chapter 74.34 RCW.
(xiii) When a patient is transferred or discharged to another provider or facility, the clinical staff must provide a summary of care to the provider or facility to whom the patient is transferred or discharged.
[Statutory Authority: RCW 18.46.060 and 43.70.250. WSR 25-15-078, s 246-329-120, filed 7/15/25, effective 8/15/25. Statutory Authority: RCW 18.46.060. WSR 10-05-033, § 246-329-120, filed 2/9/10, effective 3/12/10. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. WSR 07-07-075, § 246-329-120, filed 3/16/07, effective 4/16/07.]
PDF246-329-125
Infection control.
The purpose of this section is to identify and reduce the risk of acquiring and transmitting infections and communicable diseases between patients, staff, medical staff, and visitors.
A birthing center must:
(1) Develop and implement infection control policies and procedures consistent with the guidelines of the Centers for Disease Control and Prevention (CDC);
(2) Ensure the infection control policies and procedures address, but are not limited to, the following:
(a) Infection control practices for clinical staff including communicable disease testing, immunization, vaccination and universal precautions or equivalent method of preventing the transmission of infection according to current local health authorities and must include the availability of equipment necessary to implement plans of care and infection control policies and procedures;
(b) Receipt, use, disposal, sterilizing, processing, or reuse of equipment to prevent disease transmission;
(c) Providing and maintaining utility and storage facilities designed and equipped for washing, disinfecting, storing, and other handling of equipment and medical supplies in a manner which ensures segregation of clean and sterile supplies and equipment from those that are soiled and contaminated;
(d) Handwashing;
(e) Ensure all sewage, garbage, refuse, biohazardous waste, human tissue, needles and sharps, and liquid waste are collected and disposed of in a manner to prevent the creation of an unsafe or unsanitary condition;
(f) Tuberculosis screening for new and current employees consistent with the Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Healthcare Facilities, 2005. Morbidity Mortality Weekly Report (MMWR) Volume 54, December 30, 2005;
(g) Documenting the receipt and offer of Hepatitis B vaccination to all employees and contractors according to WAC 296-823-130; and
PDF246-329-130
Birth center equipment and supplies.
The purpose of this section is to ensure the birth center provides safe and appropriate equipment and supplies necessary for the safe provision of patient care.
(1) The applicant or licensee must ensure the birth center has the adequate, appropriate size and type equipment and supplies maintained for the client and the newborn to include:
(a) A bed suitable for labor, birth, and recovery;
(b) Oxygen with flow meters and masks or equivalent;
(c) If offering nitrous oxide, the nitrous oxide equipment must include the following:
(i) A demand valve to stop the supply when the patient is not inhaling; and
(ii) A gas waste scavenging systems to prevent secondary exposure to the exhaled/waste nitrous oxide;
(d) Suction equipment for the newborn to include bulb and delee suction devices. These devices must be immediately available in the birth center;
(e) Resuscitation equipment to include adult and neonatal resuscitation bags and term and preterm size face masks for assisted ventilation;
(f) Suitable surfaces for resuscitation. Suitable surfaces include, but are not limited to, a firm board or floor;
(g) Fetal monitoring equipment, minimally to include a fetoscope or doppler;
(h) Equipment for monitoring and maintaining the optimum body temperature of the newborn. A heat source appropriate for use in warming newborns must be available;
(i) A time keeping device such as a wall clock, smart phone, or computer;
(j) Sterile suturing equipment and supplies;
(k) Glucose meter appropriately calibrated to screen glucose level in newborns and associated test supplies;
(l) Examination lighting device with a shatterproof bulb or protective shield;
(m) Containers for soiled linen and waste materials which must be closed or covered.
(2) A telephone (land-line or cellular) or equivalent communication device must be accessible in the birthing room area.
(3) The applicant or licensee must provide and maintain infection control equipment and supplies for clinical staff.
PDF246-329-140
Patient records.
The purpose of this section is to ensure the birthing center obtains, manages, and uses information to improve patient care and outcomes.
(1) The birthing center must have a defined patient record system, policies and procedures which provide for identification, security, confidentiality, control, retrieval, and preservation of patient care data and information.
(2) The birthing center must maintain a health record for each client and newborn in a legally acceptable document consistent with chapter 70.02 RCW, Medical records—Health care information access and disclosure. Each record must include:
(a) Client's name, birth date, age, and address;
(b) Client's signed informed consent according to WAC 246-329-120(2);
(c) Signed and authenticated notes describing the client and newborn's status during labor, birth, and recovery including, but not limited to:
(i) Risk assessment completed and signed by privileged clinical staff, employed or contracted, before admission ensuring that the client is low-risk. Include the following statement: If the client develops a condition that makes them ineligible for birth center delivery, the privileged clinical staff will not admit the client to the birth center;
(ii) Labor summary;
(iii) Newborn status including Apgar scores and parent-newborn interaction;
(iv) Physical assessment of client and newborn during recovery;
(d) Documentation and authentication of orders by clinical staff and birth center personnel who administer drugs and treatments or make observations and assessments;
(e) Laboratory and diagnostic testing results pertaining to labor and immediate postpartum;
(f) Consultation reports pertaining to labor and immediate postpartum;
(g) Referral, transfer of care, emergency transfer and transport documentation pertaining to labor and immediate postpartum;
(h) Prophylactic treatment of the eyes of the newborn in accordance with WAC 246-100-202 (1)(e);
(i) Intrapartum antibiotics for Group B Strep positive clients per the CDC protocol;
(j) For Hepatitis B positive clients, HBIG and Hepatitis B immunization for newborn;
(k) Refusal of any recommended test or treatment;
(3) All care and treatment entries into the patient record must be completed in a timely fashion.
(4) Entries in the patient record must be typewritten, written legibly in ink or retrievable by electronic means.
(5) For clients managed by a contractor in a birthing center, the licensee must ensure that each patient record of labor, birth, and immediate postpartum is maintained by the birth center and must contain the information as stated in subsection (2)(a) through (k) of this section.
(6) Documentation of orders for medical treatment and medication administered by the provider. Each order must be specific to the patient and must be authenticated, at the time the order is received, by an appropriate health care professional authorized to approve the order or medication.
(7) The licensee must:
(a) Ensure patient records are kept confidential;
(b) Consider patient records property of the birth center; and
(c) Provide a patient access to their patient record under the licensee's policy and procedure and applicable rules.
(8) The licensee must maintain records for:
(a) Adults - Three years following the date of termination of services; and
(b) Minors - Three years after attaining age 18, or five years following discharge, whichever is longer.
(9) The licensee must:
(a) Store records to prevent loss of information and to maintain the integrity of the record and protect against unauthorized use;
(b) Maintain or release records after a patient's death according to chapter 70.02 RCW, Medical records—Health care information access and disclosure; and
(c) After ceasing operation, retain or dispose of records in a confidential manner according to the time frames in this subsection.
PDF246-329-150
Pharmaceuticals.
The purpose of this section is to ensure that patient pharmaceutical needs are met consistent with chapter 246-945 WAC and the following requirements:
(1) The licensee must establish and implement written policies to address the type, indications, dosage, contraindications, and side effects of any drug to be used by patients within the facility.
(2) The licensee must ensure that only local anesthetics are used. Inhaled nitrous oxide can be used as an analgesic.
(3) The licensee must ensure:
(a) Drugs are only administered by personnel or clinical staff licensed to administer drugs;
(b) Drugs kept anywhere in the center are clearly labeled with drug name, strength, and expiration date;
(c) Expired drugs are removed from the storage units and destroyed properly;
(d) Drugs are stored and secured in specifically designated cabinets, closets, drawers, or storerooms and made accessible only to authorized persons;
(e) Poisonous or caustic medications and materials including housekeeping and personal grooming supplies must show proper warning or poison labels and must be stored safely and separately from other medications and food supplies;
(f) Drugs requiring refrigeration must be kept in a separate refrigeration unit according to manufacturer's directions;
(g) Schedule II-IV controlled substances are:
(i) Kept in a separate locked storage container within a lockable room; and
(ii) If heat sensitive, kept in a refrigeration unit within a lockable room;
(iii) Schedule II-IV controlled substances no longer needed by the patient must be disposed of in compliance with chapter 246-945 WAC.
(4) Administration of medications stored at the birth center is the responsibility of the legally authorized practitioner who is administering that medication.
PDF246-329-160
Birth center—Physical environment.
The purpose of this section is to reduce and control environmental hazards and risks, prevent accidents and injuries, and maintain safe conditions and equipment for patients, visitors, and staff.
(1) The licensee must provide and maintain a safe and clean environment. The licensee must maintain the facility consistent with this chapter. Birthing centers built before the adoption of this chapter must be maintained to the standards that were in place at the time the center was originally licensed. If the licensee modifies or alters the facility, the altered areas must meet and be maintained consistent with this chapter and in accordance with the approved plans.
(2) The licensee must provide at least one birthing room. Birthing rooms must have a minimum of 156 square feet, with each dimension having a minimum of 11 feet. The room must be adequate and appropriate to provide for the equipment, staff, supplies, and emergency procedures required for the physical and emotional care of the client, newborn, and their support people during labor, birth, and the immediate postpartum period.
(3) The licensee must locate birthing rooms to provide unimpeded, rapid access to an exit of the building which will accommodate emergency transportation vehicles.
(4) The licensee must provide at least five square feet of fixed or portable work surface areas for use in the birthing room or rooms.
(5) The licensee must provide and maintain bathrooms, handwashing sinks, and bathing facilities.
(a) Bathrooms and handwashing sinks must be located in the vicinity of the birthing room or rooms.
(b) At least one bathroom must be accessible in accordance with the state adopted building code.
(c) A bathing facility must be available for patient use.
(d) The licensee must keep clean and in good repair all floor surfaces, wall surfaces, bathrooms, handwashing sinks, tubs, and showers.
(6) The licensee must provide a space suitable for storage of client and support person's personal belongings.
(7) The licensee must provide visual privacy for each client and their support person or persons.
(8) The licensee must ensure hallways and doors providing access and entry into the birth center and birthing room or rooms are adequate width and conformation to accommodate maneuvering of ambulance stretchers and wheelchairs.
(9) Water supply. The licensee must ensure an adequate supply of hot and cold running water under pressure consistent with chapter 246-290 WAC, regarding public water supplies. The licensee must provide and maintain equipment required to deliver hot water at point of use as follows: 120°F or less for handwash sinks and bathing fixtures;
(10) The licensee must provide heating and ventilation that:
(a) Provides a safe and adequate source of heat capable of maintaining a room temperature of at least 72°F.
(b) Provides ventilation sufficient to remove odors, excessive heat, and condensation.
(11) The licensee must provide and maintain lighting and power and must provide and maintain:
(a) Emergency lighting throughout the center, which can include plug-in battery pathway lighting;
(b) General lighting throughout the center;
(c) Adequate examination lighting devices with shatterproof bulbs or protective shields, in the birthing room;
(d) Tamper resistant electrical receptacles in birthing rooms, toilets, bathing facilities and family rooms and waiting areas; and
(e) Ground fault circuit interrupter (GFCI) receptacle when located within five feet of water source and above counters that contain sinks.
(12) The licensee must ensure linen and laundry service that provides:
(a) Soiled linen/laundry storage and sorting areas physically separated from clean linen storage and handling areas, kitchen and eating facilities or ensure that any work or function performed in or around a combined linen/laundry area is performed without significant risk of contamination to storing or handling clean linen/laundry;
(b) Laundry services must include a commercial laundry service or the following equipment:
(i) Washing machine(s) must have a designated sanitation cycle or laundry protocols must include chemical sanitation (e.g., bleach);
(ii) Dryer(s);
(iii) Dryer exhaust to the exterior; and
(iv) A handwashing sink for hand sanitation and a utility sink for heavily soiled linens/laundry or a two-compartment sink.
(13) The licensee must provide utility, housekeeping, garbage, and waste services.
(14) Medical gases. If medical gases are stored or used on the premises, the licensee must meet all codes and regulations:
(a) Ensure electrical equipment used in oxygen-enriched environments is designed for use with oxygen and is labeled for use with oxygen; and
(b) Post "no smoking" signs or open flames where medical gases are being administered.
(15) Food storage and preparation. The licensee must not provide food preparation and service except when the birth center policy allows the preparation or storage of personal food brought in by the client or families of clients for consumption by that family. In this case, the licensee must provide an electric or gas refrigerator capable of maintaining a temperature of 45°F or lower and if furnishing reusable utensils and dishes for client use, provide dishwashing facilities with a sanitation cycle or cleaning protocols must use chemical sanitation (e.g. bleach).
(16) An applicant or licensee wanting to use an alternative method for the design of new construction including, but not limited to, the Guidelines for Design and Construction of Health Care Facilities, may submit a request following the process in WAC 246-329-025.
PDF246-329-170
Emergency preparedness.
The purpose of this section is to establish and implement a disaster plan designed to meet both internal and external disasters.
Each applicant or licensee must:
(1) Develop and implement written policies and procedures governing emergency preparedness and fire protection;
(2) Develop an acceptable written plan, periodically rehearsed with personnel, contractors, and volunteers, to be followed in the event of an internal or external emergency, and for the care of casualties of the patient and family, personnel, contractors and volunteers arising from such emergencies; and
(3) Develop a fire protection plan to include:
(a) Instruction for all personnel, contractors or volunteers in use of alarms, firefighting equipment, methods of fire containment, evacuation routes and procedures for calling the fire department and the assignment of specific tasks to all personnel, contractors and volunteers in response to an alarm; and
(b) Semiannual evacuation and fire drills for each shift of personnel.
PDF246-329-180
Quality improvement.
The purpose of this section is to ensure that performance improvement activities of clinical staff result in continuous improvement of client health outcomes.
Each birthing center licensee must maintain a quality improvement program to ensure the quality of care and services provided that includes, at a minimum:
(1) A complaint process that includes a procedure for the receipt, investigation, and disposition of complaints regarding services;
(2) A method to identify, monitor and evaluate:
(a) Services; and
(b) Referral, transfer, consultation, and transport experience and plans; and
(c) Complications of labor and immediate postpartum; and
(d) Other aspects of services which affect quality care.
(3) A method to identify, evaluate, monitor and correct problems identified by clients, families, clinical staff, volunteers, students or consultants.
(4) A method to identify, evaluate, monitor and correct problems associated with events reported to the department in WAC 246-329-045 (3)(a) and (b) as required by chapter 70.56 RCW.
(5) A method to monitor, evaluate and modify as needed corrective actions taken.
(6) A system to assess client satisfaction.
PDF246-329-990
Fees.
The purpose of the fees section is to describe the fees associated with licensing, renewal and other charges assessed by the department.
(1) Birthing centers licensed under chapter 18.46 RCW must submit an annual fee of $713 to the department unless a center is a charitable, nonprofit, or government-operated institution under RCW 18.46.030.
(2) A change of ownership fee of $178. A new license will be issued and valid for the remainder of the current license period.
(3) The department may charge and collect from a licensee a fee of $892 for:
(a) An on-site follow-up compliance survey deemed necessary in order to complete the standard survey process;
(b) An on-site compliance survey deemed necessary due to failure of the licensee to adequately respond to a statement of deficiencies; or
(c) An on-site compliance survey deemed necessary due to a substantiated complaint investigation.
(4) A licensee must submit an additional late fee in the amount of $29 per day, not to exceed $595, from the renewal date (which is 30 days before the current license expiration date) until the date of mailing the fee, as evidenced by the postmark.
(5) Refunds. The department must refund fees paid by the applicant for initial licensure as follows:
(a) If an application has been received but no on-site survey or technical assistance has been performed by the department, two-thirds of the fees paid, less a $50 processing fee; or
(b) If an application has been received and an on-site survey or technical assistance has been performed by the department, one-third of the fees paid, less a $50 processing fee.
(c) The department may not refund applicant fees if:
(i) The department has performed more than one on-site visit for any purpose;
(ii) One year has elapsed since an initial licensure application is received by the department, but no license is issued because applicant failed to complete requirements for licensure; or
(iii) The amount to be refunded as calculated by (a) or (b) of this subsection is $10 or less.
[Statutory Authority: RCW 18.46.060 and 43.70.250. WSR 25-15-078, s 246-329-990, filed 7/15/25, effective 8/15/25. Statutory Authority: RCW 43.70.250, 70.38.105, 18.46.030, 70.127.090, 43.70.040. WSR 08-12-036, § 246-329-990, filed 5/30/08, effective 7/1/08. Statutory Authority: Chapter 18.46 RCW and RCW 43.70.040. WSR 07-07-075, § 246-329-990, filed 3/16/07, effective 4/16/07. Statutory Authority: RCW 43.70.250. WSR 06-21-108, § 246-329-990, filed 10/17/06, effective 11/17/06; WSR 05-13-189, § 246-329-990, filed 6/22/05, effective 7/23/05. Statutory Authority: RCW 43.70.250, 18.46.030, 43.70.110, 71.12.470. WSR 04-19-141, § 246-329-990, filed 9/22/04, effective 10/23/04. Statutory Authority: RCW 43.70.250 and 70.38.105(5). WSR 03-22-020, § 246-329-990, filed 10/27/03, effective 11/27/03. Statutory Authority: RCW 43.70.250. WSR 02-13-061, § 246-329-990, filed 6/14/02, effective 7/15/02. Statutory Authority: RCW 18.46.030, 43.70.110 and 43.70.250. WSR 01-15-090, § 246-329-990, filed 7/18/01, effective 8/18/01. Statutory Authority: RCW 43.70.040. WSR 91-02-050 (Order 122), § 246-329-990, filed 12/27/90, effective 1/31/91.]