Washington Administrative Code

(1) When a facility plans to close, it must notify the department, in writing, at least one hundred and eighty days before the date of closure.(2) Upon receipt of a notice of closure, the department must stop referring individuals to the facility and begin the orderly transfer of…

An individual admitted to a facility can be transferred or discharged only for:(1) Medical reasons;(2) A change in the individual's habilitation needs;(3) The individual's welfare;(4) The welfare of other residents;(5) At the request of the resident or legal guardian;(6) Partial …

The decision to transfer or discharge an individual must be based on:(1) An assessment of the resident in consultation with the service provider and the parent or guardian; and(2) A review of the relevant records; or(3) Partial closure of the facility; or(4) Closure of the facili…

(1) DDA must prepare a written plan for each resident to be transferred.(2) These plans must:(a) Identify the location of available facilities that provide services appropriate and consistent with the resident's needs;(b) Provide for coordination between the staffs of the old and…

An individual may move if:(1) The services provided to an individual do not meet their needs;(2) A facility's ICF/ID certification or license is revoked or suspended;(3) Medical reasons dictate relocation;(4) A resident's welfare would be improved;(5) The welfare of the other res…

(1) When services available to an individual do not meet their needs, the department is responsible for initiating and facilitating the resident's relocation.(2) The department may enforce immediate movement of a resident from an ICF/ID facility when the facility's ICF/ID certifi…

(1) WAC 388-835-0055 requires that DSHS give the resident and their guardian, next of kin, or responsible party thirty days notice, in writing, of its intent to transfer the resident.(2) If there is a serious and immediate threat to the resident's health or safety, DSHS is not re…

Facilities can request that a resident be transferred for the following reasons:(1) Medical reasons;(2) A change in the individual's habilitation needs;(3) The individual's welfare;(4) The welfare of the other residents;(5) Nonpayment for services provided to the resident during …

The following steps apply when a facility wants a resident transferred:(1) The facility must send their request to the department in writing. The request must explain why the relocation is necessary and document that the interdisciplinary team responsible for developing the resid…

(1) Every resident has a right to:(a) Request a transfer; and(b) Select where they wish to move.(2) If the resident's selection is available and appropriate to their habilitation and health care needs, the department must make all reasonable attempts to accomplish transfer.(3) If…

(1) A resident, their guardian, next-of-kin, or responsible party must be notified in writing at least thirty days before any transfer occurs.(2) The transfer notice must include:(a) The reasons supporting the proposed transfer;(b) A statement that the resident or any other indiv…

Advance notice and planning does not include a right to a hearing for a resident when the department concludes that the facility where the resident resides cannot provide Title XIX services due to:(1) Termination of the facility's contract;(2) Decertification of the facility;(3) …

Any facility that has an ICF/ID contract with DSHS must immediately contact their DDA regional services office regarding unauthorized leaves, disappearances, serious accidents, or other traumatic incidents effecting a resident or the resident's health or welfare.[Statutory Author…

(1) All social leaves should be consistent with the goals and objectives in the resident's individual habilitation plan.(2) Any facility vacancies resulting from a resident's social leave will be reimbursed if the leave complies with the individual habilitation plan and the follo…

(1) When an RHC resident decides to initiate a voluntarily discharge, the superintendent must determine if the discharge is harmful to the resident.(2) If the superintendent concludes that the discharge is harmful, they may detain the resident for up to forty-eight hours until th…

(1) When a superintendent detains an RHC resident, the superintendent or their designee must notify the resident and their legal representative as required in RCW 71A.10.070.(2) If the resident's legal representative is not available, the superintendent must also notify one or mo…

When a resident voluntarily leaves RHC programs and services, the superintendent must initiate discharge proceedings.[Statutory Authority: RCW 71A.20.140. WSR 01-10-013, § 388-835-0170, filed 4/20/01, effective 5/21/01.]

(1) If a facility violates the terms of their contract, DSHS may temporarily suspend referring residents to it.(2) Whenever DSHS suspends referrals it must notify the facility immediately, in writing, and give the reasons for its action.(3) The suspension may continue until DSHS …

(1) Before a contract is terminated, the provider must give DSHS one hundred and eighty days written notice of the termination.(2) When a contract is terminated, the provider must submit final reports to DSHS according to the requirements of WAC 388-835-0185.(3) When notified of …

(1) Payment for services provided before a contract was terminated, equal to the amount determined in WAC 388-835-0180(3), may be withheld by DSHS until the provider files a properly completed final annual cost report and a final settlement has been calculated.(2) Instead of with…

(1) When a final settlement is determined, security held by DSHS must be released to the provider after any related overpayments owed to the department have been paid.(2) If the provider disagrees with the settlement and does not repay any overpayments owed, DSHS must retain secu…

All surety bonds or assignment of funds, offered as security, must be:(1) At least equal in amount to the determined and/or estimated overpayments minus any withheld payments even if the overpayments are the subject of a good faith dispute;(2) Issued or accepted by a bonding comp…

A decertification, termination, or nonrenewal of a contract stops the payment of Title XIX funds. Actions such as these do not affect a facility's right to operate as a nursing home or boarding home, but they do disqualify the facility from operating as an ICF/ID facility and rec…

(1) On the effective date of a change of ownership, DSHS's contract with the former owner is terminated. The former owner must give DSHS one hundred and eighty days written notice before the contract is terminated. When a certificate of need is required for the new owner and the …

PCRRS is the system used by DSHS pay for ICF/ID services provided to ICF/ID residents. Reimbursement rates for such services are determined according to the principles, methods, and standards contained in this chapter.[Statutory Authority: RCW 71A.12.030 and 44.04.280. WSR 15-09-…

To participate in PCRRS, an entity responsible for operating an ICF/ID facility must:(1) Obtain a state certificate of need as required by chapter 70.38 RCW, Health planning and development;(2) Possess a current license to operate an appropriate facility (e.g., nursing home, boar…

(1) Unless the DDA assistant secretary approves a shorter period, each new provider must submit a one-year projected budget to DSHS at least sixty days before the contract will become effective.(2) The projected budget must cover the twelve months immediately following the date t…

(1) All cost reports must be legible and reproducible. All entries must be in black or dark blue ink or submitted in an acceptable, indelible copy.(2) All providers must complete reports according to the instructions provided by DSHS. If no specific instruction covers a particula…

(1) Every provider cost report required by DSHS must be accompanied by a certification signed on behalf of the provider who was responsible to DSHS during the reporting period.(2) If a provider files a federal income tax return, the person normally signing the return and the ICF/…

(1) Each private provider must submit an annual cost report to DSHS for the period January 1 through December 31 (calendar year) of the preceding year.(2) Annual calendar year cost reports for a private facility must be submitted to DSHS by March 31 of the following year.(3) Each…

(1) DSHS, after receiving a written request stating why an extension is necessary, may grant a maximum of two thirty-day extensions for filing any required reports. However, the written request must be received at least ten days before the due date of the reports.(2) DSHS grants …

(1) If a provider does not submit a final report, all payments received by the provider for the unreported period become a debt owed to DSHS. After receiving DSHS's written demand for repayment, the provider has thirty days to repay this debt.(2) Interest, at the rate of one perc…

(1) All providers must submit an annual report, including their proposed settlement by cost center, that is prepared according to this chapter's requirements and DSHS instructions. If an annual cost report is not properly prepared, DSHS may return it, in whole or in part, to the …

(1) Knowingly filing a report with false information (or with reason to know) is cause for termination of a provider's contract with DSHS.(2) Any required adjustments to reimbursement rates because a false report was filed will be made according to WAC 388-835-0900.(3) DSHS may r…

DSHS must consider amendments to annual reports only when:(1) Determining allowable costs affecting a final settlement computation, and(2) Filed before the provider receives notification that a DSHS field audit has been scheduled.[Statutory Authority: RCW 71A.20.140. WSR 01-10-01…

(1) A provider may file amendments after receiving a notice of a field audit only when reimbursement rates need to be adjusted because significant errors or omissions were made when they were calculated.(2) Errors of omissions are considered "significant" if they result in a net …

If DSHS does not conduct a field audit and the preliminary settlement report becomes the final report, DSHS must consider amendments only when filed within thirty days after the provider receives the final settlement report.[Statutory Authority: RCW 71A.20.140. WSR 01-10-013, § 3…

(1) When amendments are filed, a provider must report:(a) The circumstances surrounding the amendments;(b) The reasons why the amendments are needed; and(c) All relevant supporting documentation.(2) DSHS may refuse to consider any amendment that gives a provider a more favorable …

(1) A provider must, according to the terms of their contract, maintain adequate records so DSHS can audit reported data to verify provider compliance with generally accepted accounting principles and DSHS reimbursement principles and reporting instructions.(2) If a provider main…

(1) If a provider fails to maintain adequate records or fails to allow their inspection by authorized personnel, DSHS may suspend all or part of subsequent reimbursement payments due under the contract.(2) Once the provider complies with the recording keeping and inspection provi…

(1) DSHS must retain required reports for five years following their filing date.(2) If at the end of five years there are unresolved audit issues surrounding a report, the report must be retained until those issues are resolved.[Statutory Authority: RCW 71A.20.140. WSR 01-10-013…

According to chapter 388-01 WAC, all required financial and statistical reports submitted by ICF/ID facilities to DSHS are public documents and available to the public upon request.[Statutory Authority: RCW 71A.12.030 and 44.04.280. WSR 15-09-069, § 388-835-0295, filed 4/15/15, e…

A field audit consists of an on-site audit of the provider's financial records to verify that information provided on the cost report for the period being audited is accurate and represents allowable cost.[Statutory Authority: RCW 71A.12.030 and 44.04.280. WSR 15-09-069, § 388-83…

(1) DSHS may schedule cost report field audits using auditors employed by or under contract with DSHS. DSHS must notify a facility selected for an audit within one hundred twenty days after the facility submits a completed and correct cost report.(2) DSHS must give priority to fi…

(1) If auditors are given timely access to a ICF/ID facility and to all records necessary to conducting their audit, DSHS must complete an audit within one year:(a) Of receiving a properly completed annual cost report; or(b) After the facility is notified it has been selected for…

(1) A provider must allow auditors access to the ICF/ID facility and all financial and statistical records. These records must be available at a location in the state of Washington specified by the provider. They must include:(a) All income tax returns relating to the audited cos…

(1) Auditors must review a provider's record keeping and accounting practices and, where appropriate, make written recommendations for improvements.(2) Auditors must examine a provider's financial and statistical records to verify that:(a) Supporting records are in agreement with…