title: RCW 74.42.056

text:
A nursing facility shall not admit any individual who is medicaid eligible unless that individual has been assessed by the department. Appropriate hospital discharge shall not be delayed pending the assessment.
To ensure timely hospital discharge of medicaid eligible persons, the date of the request for a department long-term care assessment, or the date that nursing home care actually begins, whichever is later, shall be deemed the effective date of the initial service and payment authorization. The department shall respond promptly to such requests.
A nursing facility admitting an individual without a request for a department assessment shall not be reimbursed by the department and shall not be allowed to collect payment from a medicaid eligible individual for any care rendered before the date the facility makes a request to the department for an assessment. The date on which a nursing facility makes a request for a department long-term care assessment, or the date that nursing home care actually begins, whichever is later, shall be deemed the effective date of initial service and payment authorization for admissions regardless of the source of referral.
A medicaid eligible individual residing in a nursing facility who is transferred to an acute care hospital shall not be required to have a department assessment under this section prior to returning to the same or another nursing facility.
[ 1995 1st sp.s. c 18 s 7.]
Notes:
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.

catchline: Department assessment of medicaid eligible individuals—Requirements.


doc_type: statute

jurisdiction: wa

title: RCW 74.42.057

text:
If a nursing facility has reason to know that a resident is likely to become financially eligible for medicaid benefits within one hundred eighty days, the nursing facility shall notify the patient or his or her representative and the department. The department may:
(1) Assess any such resident to determine if the resident prefers and could live appropriately at home or in some other community-based setting; and
(2) Provide case management services to the resident.
[ 1995 1st sp.s. c 18 s 8.]
Notes:
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.

license: public-domain-government-work

rule_set: Revised Code of Washington

catchline: Notification regarding resident likely to become medicaid eligible.

code: rcw

unit: section

court: Washington State Legislature


title: RCW 74.42.058

text:
(1) To the extent of available funding, the department shall provide case management services to assist nursing facility residents, in conjunction and partnership with nursing facility staff. The purpose of the case management services is to assist residents and their families to assess the appropriateness and availability of home and community services that could meet the resident's needs so that the resident and family can make informed choices.
(2) To the extent of available funding, the department shall provide case management services to nursing facility residents who are:
(a) Medicaid funded;
(b) Dually medicaid and medicare eligible;
(c) Medicaid applicants; and
(d) Likely to become financially eligible for medicaid within one hundred eighty days, pursuant to RCW 74.42.057.
[ 1995 1st sp.s. c 18 s 9.]
Notes:
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.

catchline: Department case management services.


title: RCW 74.42.060

text:
The facility shall allow a resident or the resident's guardian to manage the resident's financial affairs. The facility may assist a resident in the management of his or her financial affairs if the resident requests assistance in writing and the facility complies with the recordkeeping requirements of RCW 74.42.130 and the provisions of *chapter . . . (Senate Bill No. 2335), Laws of 1979.
[ 1979 ex.s. c 211 s 6.]
Notes:
*Reviser's note: Senate Bill No. 2335 was not enacted during the 1979 legislative sessions. A similar bill was enacted in 1980 and became 1980 c 177, which is codified primarily in chapter 74.46 RCW.

catchline: Management of residents' financial affairs.


title: RCW 74.42.070

text:
Residents shall be given privacy during treatment and care of personal needs. Residents who are spouses or domestic partners shall be given privacy during visits with their spouses or their domestic partners. If both spouses or both domestic partners are residents of the facility, the facility shall permit the spouses or domestic partners to share a room, unless medically contraindicated.
[ 2008 c 6 s 305; 1979 ex.s. c 211 s 7.]
Notes:
Part headings not law—Severability—2008 c 6: See RCW 26.60.900 and 26.60.901.

catchline: Privacy.


title: RCW 74.42.080

text:
Residents' records, including information in an automatic data bank, shall be treated confidentially. The facility shall not release information from a resident's record to a person not otherwise authorized by law to receive the information without the resident's or the resident's guardian's written consent.
[ 1979 ex.s. c 211 s 8.]

catchline: Confidentiality of records.


title: RCW 74.42.090

text:
No resident may be required to perform services for the facility; except that a resident may be required to perform work tasks specified or included in the comprehensive plan of care.
[ 1979 ex.s. c 211 s 9.]

catchline: Work tasks by residents.


title: RCW 74.42.100

text:
The facility shall not open the personal mail that residents send or receive.
[ 1979 ex.s. c 211 s 10.]

catchline: Personal mail.


title: RCW 74.42.110

text:
Residents shall be allowed to communicate, associate, meet privately with individuals of their choice, and participate in social, religious, and community group activities unless this infringes on the rights of other residents.
[ 1979 ex.s. c 211 s 11.]

catchline: Freedom of association—Limits.


title: RCW 74.42.120

text:
The facility shall allow residents to have personal possessions as space or security permits.
[ 1979 ex.s. c 211 s 12.]

catchline: Personal possessions.


title: RCW 74.42.130

text:
The facility shall keep a current, written financial record for each resident. The record shall include written receipts for all personal possessions and funds received by or deposited with the facility and for all disbursements made to or for the resident. The resident or guardian and the resident's family shall have access to the financial record.
[ 1979 ex.s. c 211 s 13.]

catchline: Individual financial records.


title: RCW 74.42.140

text:
The facility shall care for residents by providing residents with authorized medical services which shall include treatment, medication, and diet services, and any other services contained in the comprehensive plan of care or otherwise prescribed by the attending physician.
[ 1979 ex.s. c 211 s 14.]

catchline: Prescribed plan of care—Treatment, medication, diet services.


title: RCW 74.42.150

text:
(1) Under the attending physician's instructions, qualified facility staff will establish and maintain a comprehensive plan of care for each resident which shall be kept on file by the facility and be evaluated through review and assessment by the department. The comprehensive plan contains:
(a) Goals for each resident to accomplish;
(b) An integrated program of treatment, therapies and activities to help each resident achieve those goals; and
(c) The persons responsible for carrying out the programs in the plan.
(2) Qualified facility staff shall review the comprehensive plan of care at least quarterly.
[ 1980 c 184 s 7; 1979 ex.s. c 211 s 15.]


title: RCW 74.42.160

text:
The facility shall provide the nursing care required for the classification given each resident. The nursing care shall help each resident to achieve and maintain the highest possible degree of function, self-care, and independence to the extent medically possible.
[ 1979 ex.s. c 211 s 16.]

catchline: Nursing care.


title: RCW 74.42.170

text:
(1) The facility shall provide rehabilitative services itself or arrange for the provision of rehabilitative services with qualified outside resources for each resident whose comprehensive plan of care requires the provision of rehabilitative services.
(2) The rehabilitative service personnel shall be qualified therapists, qualified therapists' assistants, or mental health professionals. Other support personnel under appropriate supervision may perform the duties of rehabilitative service personnel.
(3) The rehabilitative services shall be designed to maintain and improve the resident's ability to function independently; prevent, as much as possible, advancement of progressive disabilities; and restore maximum function.
[ 1979 ex.s. c 211 s 17.]

catchline: Rehabilitative services.


title: RCW 74.42.180

text:
(1) The facility shall provide social services, or arrange for the provision of social services with qualified outside resources, for each resident whose comprehensive plan of care requires the provision of social services.
(2) The facility shall designate one staff member qualified by training or experience to be responsible for arranging for social services in the facility or with qualified outside resources and integrating social services with other elements of the plan of care.
[ 1979 ex.s. c 211 s 18.]

catchline: Social services.


title: RCW 74.42.190

text:
The facility shall have an activities program designed to encourage each resident to maintain normal activity and help each resident return to self care. A staff member qualified by experience or training in directing group activities shall be responsible for the activities program. The facility shall provide adequate recreation areas with sufficient equipment and materials to support the program.
[ 1979 ex.s. c 211 s 19.]

catchline: Activities program—Recreation areas, equipment.


title: RCW 74.42.200

text:
The health care of each resident shall be under the continuing supervision of a physician: PROVIDED, That a resident of a facility licensed pursuant to chapter 18.51 RCW but not certified by the federal government under Title XVIII or Title XIX of the Social Security Act as now or hereafter amended shall not be required to receive the continuing supervision of a health care practitioner licensed pursuant to chapter 18.22, 18.25, 18.32, 18.57, 18.71, and 18.83 RCW, nor shall the state of Washington require such continuing supervision as a condition of licensing. The physician shall see the resident whenever necessary, and as required and/or consistent with state and federal regulations.
[ 1980 c 184 s 8; 1979 ex.s. c 211 s 20.]

catchline: Supervision of health care by physician—When required.


title: RCW 74.42.210

text:
The facility shall either employ a licensed pharmacist responsible for operating the facility's pharmacy or have a written agreement with a licensed pharmacist who will advise the facility on ordering, storage, administration, disposal, and recordkeeping of drugs and biologicals.
[ 1979 ex.s. c 211 s 21.]

catchline: Pharmacist services.


title: RCW 74.42.220

text:
(1) If the facility does not employ a qualified professional to furnish required services, the facility shall have a written contract with a qualified professional or agency outside the facility to furnish the required services. The terms of the contract, including terms about responsibilities, functions, and objectives, shall be specified. The contract shall be signed by the administrator, or the administrator's representative, and the qualified professional.
(2) All contracts for these services shall require the standards in RCW 74.42.010 through 74.42.570 to be met.
[ 1980 c 184 s 9; 1979 ex.s. c 211 s 22.]

catchline: Contracts for professional services from outside the agency.


title: RCW 74.42.225

text:
The department shall develop an educational program for attending and staff physicians and patients on self-medication. The department shall actively encourage the implementation of such self-medication programs for residents.
[ 1980 c 184 s 18.]

catchline: Self-medication programs for residents—Educational program—Implementation.


title: RCW 74.42.230

text:
(1) The resident's attending or staff physician or authorized practitioner approved by the attending physician shall order all medications for the resident. The order may be oral or written and shall continue in effect until discontinued by a physician or other authorized prescriber, unless the order is specifically limited by time. An "authorized practitioner," as used in this section, is a registered nurse under chapter 18.79 RCW when authorized by the state board of nursing, a physician assistant under chapter 18.71A RCW when authorized by the Washington medical commission, or a pharmacist under chapter 18.64 RCW when authorized by the pharmacy quality assurance commission.
(2) An oral order shall be given only to a licensed nurse, pharmacist, or another physician. The oral order shall be recorded and physically or electronically signed immediately by the person receiving the order. The attending physician shall sign the record of the oral order in a manner consistent with good medical practice.
(3) A licensed nurse, pharmacist, or another physician receiving and recording an oral order may, if so authorized by the physician or authorized practitioner, communicate that order to a pharmacy on behalf of the physician or authorized practitioner. The order may be communicated verbally by telephone, by facsimile manually signed by the person receiving the order pursuant to subsection (2) of this section, or by electronic transmission pursuant to RCW 69.41.055. The communication of a resident's order to a pharmacy by a licensed nurse, pharmacist, or another physician acting at the prescriber's direction has the same force and effect as if communicated directly by the delegating physician or authorized practitioner. Nothing in this provision limits the authority of a licensed nurse, pharmacist, or physician to delegate to an authorized agent, including but not limited to delegation of operation of a facsimile machine by credentialed facility staff, to the extent consistent with his or her professional license.
[ 2025 c 58 s 5057; 2020 c 80 s 57; 2019 c 55 s 20; 2016 c 148 s 9; 1994 sp.s. c 9 s 751; 1982 c 120 s 2; 1979 ex.s. c 211 s 23.]
Notes:
Explanatory note—2025 c 58: See note following RCW 1.16.050.
Effective date—2020 c 80 ss 12-59: See note following RCW 7.68.030.
Intent—2020 c 80: See note following RCW 18.71A.010.
Severability—Headings and captions not law—Effective date—1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.

catchline: Physician or authorized practitioner to prescribe medication—Communication of order by licensed nurse, pharmacist, or another physician.


title: RCW 74.42.240

text:
(1) No staff member may administer any medication to a resident unless the staff member is licensed to administer medication: PROVIDED, That nothing herein shall be construed as prohibiting graduate nurses or student nurses from administering medications when permitted to do so under chapter 18.79 RCW and rules adopted thereunder.
(2) The facility may only allow a resident to give himself or herself medication with the attending physician's permission.
(3) Medication shall only be administered to or used by the resident for whom it is ordered.
[ 1994 sp.s. c 9 s 752; 1989 c 372 s 5; 1979 ex.s. c 211 s 24.]
Notes:
Severability—Headings and captions not law—Effective date—1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.

catchline: Administering medication.


title: RCW 74.42.250

text:
(1) When the physician's order for medication does not include a specific time limit or a specific number of dosages, the facility shall notify the physician that the medication will be stopped at a date certain unless the medication is ordered continued by the physician. The facility shall so notify the physician every thirty days.
(2) A facility for the developmentally disabled shall have an automatic stop order on all drugs, unless such stoppage will place the patient in jeopardy.
[ 1979 ex.s. c 211 s 25.]

catchline: Medication stop orders—Procedure for persons with developmental disabilities.


title: RCW 74.42.260

text:
(1) The facility shall store drugs under proper conditions of sanitation, temperature, light, moisture, ventilation, segregation, and security. Poisons, drugs used externally, and drugs taken internally shall be stored on separate shelves or in separate cabinets at all locations. When medication is stored in a refrigerator containing other items, the medication shall be kept in a separate compartment with proper security. All drugs shall be kept under lock and key unless an authorized individual is in attendance.
(2) The facility shall meet the drug security requirements of federal and state laws that apply to storerooms, pharmacies, and living units.
(3) If there is a drug storeroom separate from the pharmacy, the facility shall keep a perpetual inventory of receipts and issues of all drugs from that storeroom.
[ 1979 ex.s. c 211 s 26.]

catchline: Drug storage, security, inventory.


title: RCW 74.42.270

text:
Any drug that is discontinued or outdated and any container with a worn, illegible, or missing label shall be properly disposed.
[ 1979 ex.s. c 211 s 27.]

catchline: Drug disposal.


title: RCW 74.42.280

text:
Medication errors and adverse drug reactions shall be recorded and reported immediately to the practitioner who ordered the drug. The facility shall report adverse drug reactions consistent with good medical practice.
[ 1979 ex.s. c 211 s 28.]

catchline: Adverse drug reaction.


title: RCW 74.42.285

text:
(1) Long-term care facilities shall:
(a) Provide access on-site or make available elsewhere for all residents to obtain the influenza virus immunization on an annual basis;
(b) Require that each resident, or the resident's legal representative, upon admission to the facility, be informed verbally and in writing of the benefits of receiving the influenza virus immunization and, if not previously immunized against pneumococcal disease, the benefits of the pneumococcal immunization.
(2) As used in this section, "long-term care facility" is limited to nursing homes licensed under chapter 18.51 RCW.
(3) The department of social and health services shall adopt rules to implement this section.
(4) This section and rules adopted under this section shall not apply to nursing homes conducted for those who rely exclusively upon treatment by nonmedical religious healing methods, including prayer.
[ 2002 c 256 s 2.]
Notes:
Intent—Findings—2002 c 256: "It is the intent of the legislature to ensure that long-term care facilities are safe.
(1) The long-term care resident immunization act is intended to:
(a) Prevent and reduce the occurrence and severity of the influenza virus and pneumococcal disease by increasing the use of immunizations licensed by the food and drug administration;
(b) Avoid pain, suffering, and deaths that may result from the influenza virus and pneumococcal disease;
(c) Improve the well-being and quality of life of residents of long-term care facilities; and
(d) Reduce avoidable costs associated with treating the influenza virus and pneumococcal disease.
(2) The legislature finds that:
(a) Recent studies show that it is important to immunize older citizens against the influenza virus and pneumococcal disease;
(b) The centers for disease control and prevention recommend individuals living in long-term care facilities and those over age sixty-five receive immunizations against the influenza virus and pneumococcal disease;
(c) The influenza virus and pneumococcal disease have been identified as leading causes of death for citizens over age sixty-five; and
(d) Immunizations licensed by the food and drug administration are readily available and effective in reducing and preventing the severity of the influenza virus and pneumococcal disease." [ 2002 c 256 s 1.]
Short title—2002 c 256: "This act may be known and cited as the long-term care resident immunization act of 2002." [ 2002 c 256 s 3.]

catchline: Immunizations—Rules.


title: RCW 74.42.290

text:
(1) The facility shall serve at least three meals, or their equivalent, daily at regular times with not more than fourteen hours between a substantial evening meal and breakfast on the following day and not less than ten hours between breakfast and a substantial evening meal on the same day.
(2) Food shall be procured, stored, transported, and prepared under sanitary conditions in compliance with state and local regulations.
(3) Food of an appropriate quantity at an appropriate temperature shall be served in a form consistent with the needs of the resident;
(4) Special eating equipment and utensils shall be provided for residents who need them; and
(5) Food served and uneaten shall be discarded.
[ 1979 ex.s. c 211 s 29.]


title: RCW 74.42.300

text:
(1) The facility shall have a staff member trained or experienced in food management and nutrition responsible for planning menus that meet the requirements of subsection (2) of this section and supervising meal preparation and service to insure that the menu plan is followed.
(2) The menu plans shall follow the orders of the resident's physician.
(3) The facility shall:
(a) Meet the nutritional needs of each resident;
(b) Have menus written in advance;
(c) Provide a variety of foods at each meal;
(d) Provide daily and weekly variations in the menus; and
(e) Adjust the menus for seasonal changes.
(4) If the facility has residents who require medically prescribed special diets, the menus for those residents shall be planned by a professionally qualified dietitian or reviewed and approved by the attending physician. The preparation and serving of meals shall be supervised to insure that the resident accepts the special diet.
[ 1979 ex.s. c 211 s 30.]

catchline: Nutritionist—Menus, special diets.


title: RCW 74.42.310

text:
(1) A facility shall have sufficient personnel to supervise the residents, direct self-help dining skills, and to insure that each resident receives enough food.
(2) A facility shall provide table service for all residents, including residents in wheelchairs, who are capable and willing to eat at tables.
[ 1980 c 184 s 10; 1979 ex.s. c 211 s 31.]

catchline: Staff duties at meals.


title: RCW 74.42.320

text:
Facilities shall have effective sanitary procedures for the food preparation staff including procedures for cleaning food preparation equipment and food preparation areas.
[ 1979 ex.s. c 211 s 32.]

catchline: Sanitary procedures for food preparation.


title: RCW 74.42.330

text:
The facility shall store dry or staple food items at an appropriate height above the floor in a ventilated room not subject to sewage or wastewater backflow or contamination by condensation, leakage, rodents or vermin. Perishable foods shall be stored at proper temperatures to conserve nutritive values.
[ 1979 ex.s. c 211 s 33.]

catchline: Food storage.


title: RCW 74.42.340

text:
(1) The facility shall provide adequate administrative support to efficiently meet the needs of residents and facilitate attainment of the facility's goals and objectives.
(2) The facility shall:
(a) Document the purchasing process;
(b) Adequately operate the inventory control system and stockroom;
(c) Have appropriate storage facilities for all supplies and surplus equipment; and
(d) Train and assist personnel to do purchase, supply, and property control functions.
[ 1980 c 184 s 11; 1979 ex.s. c 211 s 34.]


title: RCW 74.42.350

text:
The facility shall have and keep current an organization chart showing:
(1) The major operating programs of the facility;
(2) The staff divisions of the facility;
(3) The administrative personnel in charge of the programs and divisions; and
(4) The lines of authority, responsibility, and communication of administrative personnel.
[ 1979 ex.s. c 211 s 35.]

catchline: Organization chart.


title: RCW 74.42.360

text:
(1) The facility shall have staff on duty twenty-four hours daily sufficient in number and qualifications to carry out the provisions of RCW 74.42.010 through 74.42.570 and the policies, responsibilities, and programs of the facility.
(2) The department shall institute minimum staffing standards for nursing homes. Beginning July 1, 2016, facilities must provide a minimum of 3.4 hours per resident day of direct care. Direct care staff has the same meaning as defined in RCW 74.42.010. The minimum staffing standard includes the time when such staff are providing hands-on care related to activities of daily living and nursing-related tasks, as well as care planning. The legislature intends to increase the minimum staffing standard to 4.1 hours per resident day of direct care, but the effective date of a standard higher than 3.4 hours per resident day of direct care will be identified if and only if funding is provided explicitly for an increase of the minimum staffing standard for direct care.
(a) The department shall establish in rule a system of compliance of minimum direct care staffing standards by January 1, 2016. Oversight must be done at least quarterly using the centers for medicare and medicaid services' payroll-based journal and nursing home facility census and payroll data.
(b) The department shall establish in rule by January 1, 2016, a system of financial penalties for facilities out of compliance with minimum staffing standards. No monetary penalty may be issued during the implementation period of July 1, 2016, through September 30, 2016. If a facility is found noncompliant during the implementation period, the department shall provide a written notice identifying the staffing deficiency and require the facility to provide a sufficiently detailed correction plan to meet the statutory minimum staffing levels. Monetary penalties begin October 1, 2016. Monetary penalties must be established based on a formula that calculates the cost of wages and benefits for the missing staff hours. If a facility meets the requirements in subsection (3) or (4) of this section, the penalty amount must be based solely on the wages and benefits of certified nurse aides. The first monetary penalty for noncompliance must be at a lower amount than subsequent findings of noncompliance. Monetary penalties established by the department may not exceed two hundred percent of the wage and benefit costs that would have otherwise been expended to achieve the required staffing minimum hours per resident day for the quarter. A facility found out of compliance must be assessed a monetary penalty at the lowest penalty level if the facility has met or exceeded the requirements in subsection (2) of this section for three or more consecutive years. Beginning July 1, 2016, pursuant to rules established by the department, funds that are received from financial penalties must be used for technical assistance, specialized training, or an increase to the quality enhancement established in RCW 74.46.561.
(c) The department shall establish in rule an exception allowing geriatric behavioral health workers as defined in RCW 74.42.010 to be recognized in the minimum staffing requirements as part of the direct care service delivery to individuals who have a behavioral health condition. Hours worked by geriatric behavioral health workers may be recognized as direct care hours for purposes of the minimum staffing requirements only up to a portion of the total hours equal to the proportion of resident days of clients with a behavioral health condition identified at that facility on the most recent semiannual minimum data set. In order to qualify for the exception:
(i) The worker must:
(A) Have a bachelor's or master's degree in social work, behavioral health, or other related areas; or
(B) Have at least three years experience providing care for individuals with chronic mental health issues, dementia, or intellectual and developmental disabilities in a long-term care or behavioral health care setting; or
(C) Have successfully completed a facility-based behavioral health curriculum approved by the department under RCW 74.39A.078;
(ii) Any geriatric behavioral health worker holding less than a master's degree in social work must be directly supervised by an employee who has a master's degree in social work or a registered nurse.
(d)(i) The department shall establish a limited exception to the 3.4 hours per resident day staffing requirement for facilities demonstrating a good faith effort to hire and retain staff.
(ii) To determine initial facility eligibility for exception consideration, the department shall send surveys to facilities anticipated to be below, at, or slightly above the 3.4 hours per resident day requirement. These surveys must measure the hours per resident day in a manner as similar as possible to the centers for medicare and medicaid services' payroll-based journal and cover the staffing of a facility from October through December of 2015, January through March of 2016, and April through June of 2016. A facility must be below the 3.4 staffing standard on all three surveys to be eligible for exception consideration. If the staffing hours per resident day for a facility declines from any quarter to another during the survey period, the facility must provide sufficient information to the department to allow the department to determine if the staffing decrease was deliberate or a result of neglect, which is the lack of evidence demonstrating the facility's efforts to maintain or improve its staffing ratio. The burden of proof is on the facility and the determination of whether or not the decrease was deliberate or due to neglect is entirely at the discretion of the department. If the department determines a facility's decline was deliberate or due to neglect, that facility is not eligible for an exception consideration.
(iii) To determine eligibility for exception approval, the department shall review the plan of correction submitted by the facility. Before a facility's exception may be renewed, the department must determine that sufficient progress is being made towards reaching the 3.4 hours per resident day staffing requirement. When reviewing whether to grant or renew an exception, the department must consider factors including but not limited to: Financial incentives offered by the facilities such as recruitment bonuses and other incentives; the robustness of the recruitment process; county employment data; specific steps the facility has undertaken to improve retention; improvements in the staffing ratio compared to the baseline established in the surveys and whether this trend is continuing; and compliance with the process of submitting staffing data, adherence to the plan of correction, and any progress toward meeting this plan, as determined by the department.
(iv) Only facilities that have their direct care component rate increase capped according to RCW 74.46.561 are eligible for exception consideration. Facilities that will have their direct care component rate increase capped for one or two years are eligible for exception consideration through June 30, 2017. Facilities that will have their direct care component rate increase capped for three years are eligible for exception consideration through June 30, 2018.
(v) The department may not grant or renew a facility's exception if the facility meets the 3.4 hours per resident day staffing requirement and subsequently drops below the 3.4 hours per resident day staffing requirement.
(vi) The department may grant exceptions for a six-month period per exception. The department's authority to grant exceptions to the 3.4 hours per resident day staffing requirement expires June 30, 2018.
(3)(a) Large nonessential community providers must have a registered nurse on duty directly supervising resident care twenty-four hours per day, seven days per week.
(b)(i) The department shall establish a limited exception process for large nonessential community providers that can demonstrate a good faith effort to hire a registered nurse for the last eight hours of required coverage per day. In granting an exception, the department may consider the competitiveness of the wages and benefits offered as compared to nursing facilities in comparable geographic or metropolitan areas within Washington state, the provider's recruitment and retention efforts, and the availability of registered nurses in the particular geographic area. A one-year exception may be granted and may be renewable; however, the department may limit the admission of new residents, based on medical conditions or complexities, when a registered nurse is not on-site and readily available. If a large nonessential community provider receives an exception, that information must be included in the department's nursing home locator.
(ii) By August 1, 2023, and every three years thereafter, the department, along with a stakeholder work group established by the department, shall conduct a review of the exceptions process to determine if it is still necessary. As part of this review, the department shall provide the legislature with a report that includes enforcement and citation data for large nonessential community providers that were granted an exception in the three previous fiscal years in comparison to those without an exception. The report must include a similar comparison of data, provided to the department by the long-term care ombuds, on long-term care ombuds referrals for large nonessential community providers that were granted an exception in the three previous fiscal years and those without an exception. This report, along with a recommendation as to whether the exceptions process should continue, is due to the legislature by December 1st of each year in which a review is conducted. Based on the recommendations outlined in this report, the legislature may take action to end the exceptions process.
(4) Essential community providers and small nonessential community providers must have a registered nurse on duty directly supervising resident care a minimum of sixteen hours per day, seven days per week, and a registered nurse or a licensed practical nurse on duty directly supervising resident care the remaining eight hours per day, seven days per week.
(5) For the purposes of this section, "behavioral health condition" means one or more of the behavioral symptoms specified in section E of the minimum data set.
(6) If a pandemic, natural disaster, or other declared state of emergency impedes or prevents facilities from compliance with subsections (2) through (4) of this section, the department may adopt rules to grant exceptions to these requirements, waive penalties, and suspend oversight activities. Facilities must remain in compliance with subsection (1) of this section. Rules adopted under this subsection are effective until 12 months after the termination of the pandemic, natural disaster, or other declared state of emergency or until determined no longer necessary by the department, whichever occurs first. Once the department determines a rule adopted under this subsection is no longer necessary, it must repeal the rule under RCW 34.05.353.
[ 2021 c 203 s 6; 2020 c 263 s 3; 2019 c 12 s 2; 2017 c 200 s 3; 2016 c 131 s 2; 2015 2nd sp.s. c 2 s 7; 1979 ex.s. c 211 s 36.]
Notes:
Effective date—Retroactive application—2021 c 203: See notes following RCW 43.43.832.
Effective date—2015 2nd sp.s. c 2: See note following RCW 74.46.501.

catchline: Adequate staff—Minimum staffing standards—Exceptions—Definition.


title: RCW 74.42.370

text:
The facility shall have an administrator who is a licensed nursing home administrator under chapter 18.52 RCW. The administrator is responsible for managing the facility and implementing established policies and procedures.
[ 1979 ex.s. c 211 s 37.]

catchline: Licensed administrator.


title: RCW 74.42.380

text:
(1) The facility shall have a director of nursing services. The director of nursing services shall be a registered nurse or an *advanced registered nurse practitioner.
(2) The director of nursing services is responsible for:
(a) Coordinating the plan of care for each resident;
(b) Permitting only licensed personnel to administer medications: PROVIDED, That nothing herein shall be construed as prohibiting graduate nurses or student nurses from administering medications when permitted to do so under chapter 18.79 RCW and rules adopted under it: PROVIDED FURTHER, That nothing herein shall be construed as prohibiting persons certified under **chapter 18.135 RCW from practicing pursuant to the delegation and supervision requirements of **chapter 18.135 RCW and rules adopted under it; and
(c) Insuring that the licensed practical nurses and the registered nurses comply with chapter 18.79 RCW, and persons certified under **chapter 18.135 RCW comply with the provisions of that chapter and rules adopted under it.
[ 1994 sp.s. c 9 s 753; 1989 c 372 s 6; 1985 c 284 s 2; 1979 ex.s. c 211 s 38.]
Notes:
Reviser's note: *(1) The term "advanced registered nurse practitioner" was changed to "advanced practice registered nurse" by 2024 c 239 s 1, effective June 30, 2027.
**(2) Chapter 18.135 RCW was repealed by 2012 c 153 s 20.
Severability—Headings and captions not law—Effective date—1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.
PDF
RCW 74.42.380
Director of nursing services. (Effective June 30, 2027.)
(1) The facility shall have a director of nursing services. The director of nursing services shall be a registered nurse or an advanced practice registered nurse.
(2) The director of nursing services is responsible for:
(a) Coordinating the plan of care for each resident;
(b) Permitting only licensed personnel to administer medications: PROVIDED, That nothing herein shall be construed as prohibiting graduate nurses or student nurses from administering medications when permitted to do so under chapter 18.79 RCW and rules adopted under it: PROVIDED FURTHER, That nothing herein shall be construed as prohibiting persons certified under *chapter 18.135 RCW from practicing pursuant to the delegation and supervision requirements of *chapter 18.135 RCW and rules adopted under it; and
(c) Insuring that the licensed practical nurses and the registered nurses comply with chapter 18.79 RCW, and persons certified under *chapter 18.135 RCW comply with the provisions of that chapter and rules adopted under it.
[ 2025 c 58 s 5170; 1994 sp.s. c 9 s 753; 1989 c 372 s 6; 1985 c 284 s 2; 1979 ex.s. c 211 s 38.]
Notes:
*Reviser's note: Chapter 18.135 RCW was repealed by 2012 c 153 s 20.
Effective date—2025 c 58 ss 5058-5170: See note following RCW 7.68.030.
Explanatory note—2025 c 58: See note following RCW 1.16.050.
Severability—Headings and captions not law—Effective date—1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.

catchline: Director of nursing services. (Effective until June 30, 2027.)


title: RCW 74.42.390

text:
The facility shall have a communication system, including telephone service, that insures prompt contact of on-duty personnel and prompt notification of responsible personnel in an emergency.
[ 1979 ex.s. c 211 s 39.]

catchline: Communication system.


title: RCW 74.42.400

text:
The facility shall have sufficient trained and experienced personnel for necessary engineering and maintenance functions.
[ 1979 ex.s. c 211 s 40.]

catchline: Engineering and maintenance personnel.


title: RCW 74.42.410

text:
The facility shall manage laundry services to meet the residents' daily clothing and linen needs. The facility shall have available at all times enough linen for the proper care and comfort of the residents.
[ 1979 ex.s. c 211 s 41.]

catchline: Laundry services.


title: RCW 74.42.420

text:
The facility shall maintain an organized record system containing a record for each resident. The record shall contain:
(1) Identification information, including the information listed in RCW 18.51.095(1);
(2) Admission information, including the resident's medical and social history;
(3) A comprehensive plan of care and subsequent changes to the comprehensive plan of care;
(4) Copies of initial and subsequent periodic examinations, assessments, evaluations, and progress notes made by the facility and the department;
(5) Descriptions of all treatments, services, and medications provided for the resident since the resident's admission;
(6) Information about all illnesses and injuries including information about the date, time, and action taken; and
(7) A discharge summary.
Resident records shall be available to the staff members directly involved with the resident and to appropriate representatives of the department. The facility shall protect resident records against destruction, loss, and unauthorized use. The facility shall keep a resident's record after the resident is discharged as provided in RCW 18.51.300.
[ 2021 c 159 s 10; 1979 ex.s. c 211 s 42.]
Notes:
Findings—2021 c 159: See note following RCW 18.20.520.

catchline: Resident record system.


title: RCW 74.42.430

text:
The facility shall develop written guidelines governing:
(1) All services provided by the facility;
(2) Admission, transfer or discharge;
(3) The use of chemical and physical restraints, the personnel authorized to administer restraints in an emergency, and procedures for monitoring and controlling the use of the restraints;
(4) Procedures for receiving and responding to residents' complaints and recommendations;
(5) Access to, duplication of, and dissemination of information from the resident's record;
(6) Residents' rights, privileges, and duties;
(7) Procedures if the resident is adjudicated incompetent or incapable of understanding his or her rights and responsibilities;
(8) When to recommend initiation of guardianship, conservatorship, or other protective arrangement proceedings under chapter 11.130 RCW;
(9) Emergencies;
(10) Procedures for isolation of residents with infectious diseases; and
(11) Procedures for residents to refuse treatment and for the facility to document informed refusal.
The written guidelines shall be made available to the staff, residents, members of residents' families, and the public.
[ 2020 c 312 s 739; 1980 c 184 s 12; 1979 ex.s. c 211 s 43.]
Notes:
Effective dates—2020 c 312: See note following RCW 11.130.915.

catchline: Written policy guidelines.


title: RCW 74.42.440

text:
The facility may only admit individuals when the facility's rated capacity will not be exceeded and when the facility has the capability to provide adequate treatment, therapy, and activities.
[ 1979 ex.s. c 211 s 44.]

catchline: Facility rated capacity not to be exceeded.


title: RCW 74.42.450

text:
(1) The facility shall admit as residents only those individuals whose needs can be met by:
(a) The facility;
(b) The facility cooperating with community resources; or
(c) The facility cooperating with other providers of care affiliated or under contract with the facility.
(2) The facility shall transfer a resident to a hospital or other appropriate facility when a change occurs in the resident's physical or mental condition that requires care or service that the facility cannot provide. The resident, the resident's guardian, if any, the resident's next of kin, the attending physician, and the department shall be consulted at least fifteen days before a transfer or discharge unless the resident is transferred under emergency circumstances. The department shall use casework services or other means to insure that adequate arrangements are made to meet the resident's needs.
(3) A resident shall be transferred or discharged only for medical reasons, the resident's welfare or request, the welfare of other residents, or nonpayment. A resident may not be discharged for nonpayment if the discharge would be prohibited by the medicaid program.
(4) If a resident chooses to remain in the nursing facility, the department shall respect that choice, provided that if the resident is a medicaid recipient, the resident continues to require a nursing facility level of care.
(5) If the department determines that a resident no longer requires a nursing facility level of care, the resident shall not be discharged from the nursing facility until at least thirty days after written notice is given to the resident, the resident's surrogate decision maker and, if appropriate, a family member or the resident's representative. A form for requesting a hearing to appeal the discharge decision shall be attached to the written notice. The written notice shall include at least the following:
(a) The reason for the discharge;
(b) A statement that the resident has the right to appeal the discharge; and
(c) The name, address, and telephone number of the state long-term care ombuds.
(6) If the resident appeals a department discharge decision, the resident shall not be discharged without the resident's consent until at least thirty days after a final order is entered upholding the decision to discharge the resident.
(7) Before the facility transfers or discharges a resident, the facility must first attempt through reasonable accommodations to avoid the transfer or discharge unless the transfer or discharge is agreed to by the resident. The facility shall admit or retain only individuals whose needs it can safely and appropriately serve in the facility with available staff or through the provision of reasonable accommodations required by state or federal law. "Reasonable accommodations" has the meaning given to this term under the federal Americans with disabilities act of 1990, 42 U.S.C. Sec. 12101 et seq. and other applicable federal or state antidiscrimination laws and regulations.
[ 2013 c 23 s 229; 1997 c 392 s 216; 1995 1st sp.s. c 18 s 64; 1979 ex.s. c 211 s 45.]
Notes:
Short title—Findings—Construction—Conflict with federal requirements—Part headings and captions not law—1997 c 392: See notes following RCW 74.39A.009.
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.

catchline: Residents limited to those the facility qualified to care for—Transfer or discharge of residents—Appeal of department discharge decision—Reasonable accommodation.


title: RCW 74.42.455

text:
(1) Nursing facilities may provide telephone or web-based transitional care management services to persons discharged from the facility to home for up to thirty days postdischarge.
(2) When a nursing facility provides transitional care management services, the facility must coordinate postdischarge care and service needs with in-home agencies licensed under chapter 70.127 RCW, and other authorized care providers, to promote evidence-based transition care planning. In-home service agencies and other authorized care providers, including the department, shall, when appropriate, determine resident eligibility for postdischarge care and services and coordinate with nursing facilities to plan a safe transition of the client to the home setting. When a resident is discharged to home and is without in-home care or services due to the resident's refusal of care or their ineligibility for care, the nursing facility may provide telephone or web-based transitional care management services. These services may include care coordination services, review of the discharge plan, instructions to promote compliance with the discharge plan, reminders or assistance with scheduling follow-up appointments with other health care professionals consistent with the discharge plan, and promotion of self-management of the client's health condition. Web-based transition care services may include patient education and the provision of services described in this section. They are not intended to include telehealth monitoring.
(3) If the nursing facility identifies concerns in client care that result from telephone or web-based transitional care management services, the nursing facility will notify the client's primary care physician. The nursing facility will also discuss with the client options for care or other services which may include in-home services provided by agencies licensed under chapter 70.127 RCW.
[ 2011 c 366 s 7.]
Notes:
Findings—Purpose—Conflict with federal requirements—2011 c 366: See notes following RCW 18.20.020.

catchline: Transitional care management.


title: RCW 74.42.460

text:
The facility shall have a written staff organization plan and detailed written procedures to meet potential emergencies and disasters. The facility shall clearly communicate and periodically review the plan and procedures with the staff and residents. The plan and procedures shall be posted at suitable locations throughout the facility. The planning requirement of this section shall complement the comprehensive disaster preparedness planning requirement of RCW 18.51.580.
[ 2021 c 159 s 12; 1979 ex.s. c 211 s 46.]
Notes:
Findings—2021 c 159: See note following RCW 18.20.520.

catchline: Organization plan and procedures.


title: RCW 74.42.470

text:
No employee with symptoms of a communicable disease may work in a facility. The facility shall have written guidelines that will help enforce this section.
[ 1979 ex.s. c 211 s 47.]

catchline: Infected employees.


title: RCW 74.42.480

text:
The facility shall design and equip the resident living areas for the comfort and privacy of each resident.
[ 1979 ex.s. c 211 s 48.]

catchline: Living areas.


title: RCW 74.42.490

text:
Each resident's room shall:
(1) Be equipped with or conveniently located near toilet and bathing facilities;
(2) Be at or above grade level;
(3) Contain a suitable bed for each resident and other appropriate furniture;
(4) Have closet space that provides security and privacy for clothing and personal belongings;
(5) Contain no more than four beds;
(6) Have adequate space for each resident; and
(7) Be equipped with a device for calling the staff member on duty.
The department may waive the space, occupancy, and certain equipment requirements of this section for an existing building constructed prior to January 1, 1980, or space and certain equipment for new intermediate care facilities for persons with intellectual disabilities for as long as the department considers appropriate if the department finds that the requirements would result in unreasonable hardship on the facility, the waiver serves the particular needs of the residents, and the waiver does not adversely affect the health and safety of the residents.
[ 2010 c 94 s 28; 1980 c 184 s 13; 1979 ex.s. c 211 s 49.]
Notes:
Purpose—2010 c 94: See note following RCW 44.04.280.

catchline: Room requirements—Waiver.


title: RCW 74.42.500

text:
Toilet and bathing facilities shall be located in or near residents' rooms and shall be appropriate in number, size, and design to meet the needs of the residents. The facility shall provide an adequate supply of hot water at all times for resident use. Plumbing shall be equipped with control valves that automatically regulate the temperature of the hot water used by residents.
[ 1979 ex.s. c 211 s 50.]

catchline: Toilet and bathing facilities.


title: RCW 74.42.510

text:
The facility shall provide one or more areas not used for corridor traffic for dining, recreation, and social activities. A multipurpose room may be used if it is large enough to accommodate all of the activities without the activities interfering with each other: PROVIDED, That the department may waive the provisions of this section for facilities constructed prior to January 1, 1980.
[ 1979 ex.s. c 211 s 51.]

catchline: Room for dining, recreation, social activities—Waiver.


title: RCW 74.42.520

text:
The facility's therapy area shall be large enough and designed to accommodate the necessary equipment, conduct an examination, and provide treatment: PROVIDED, That developmentally disabled facilities shall not be subject to the provisions of this section if therapeutic services are obtained by contract with other facilities.
[ 1979 ex.s. c 211 s 52.]

catchline: Therapy area.


title: RCW 74.42.530

text:
The facility shall have isolation areas for residents with infectious diseases or make other provisions for isolating these residents.
[ 1979 ex.s. c 211 s 53.]

catchline: Isolation areas.


title: RCW 74.42.540

text:
(1) The facility shall be accessible to and usable by all residents, personnel, and the public, including individuals with disabilities: PROVIDED, That no substantial structural changes shall be required in any facilities constructed prior to January 1, 1980.
(2) The facility shall meet the requirements of American national standards institute (ANSI) standard No. A117.1 (1961), or, if applicable, the requirements of chapter 70.92 RCW if the requirements are stricter than ANSI standard No. A117.1 (1961), unless the department waives the requirements of ANSI standard No. A117.1 (1961) under subsection (3) of this section.
(3) The department may waive, for as long as the department considers appropriate, provisions of ANSI standard No. A117.1 (1961) if:
(a) The construction plans for the facility or a part of the facility were approved by the department before March 18, 1974;
(b) The provisions would result in unreasonable hardship on the facility if strictly enforced; and
(c) The waiver does not adversely affect the health and safety of the residents.
[ 1979 ex.s. c 211 s 54.]

catchline: Building requirements.


title: RCW 74.42.550

text:
The facility shall have handrails that are firmly attached to the walls in all corridors used by residents: PROVIDED, That the department may waive the provisions of this section in developmentally disabled facilities.
[ 1979 ex.s. c 211 s 55.]

catchline: Handrails.


title: RCW 74.42.560

text:
If a living unit of a facility for the developmentally disabled houses more than fifteen residents, the living unit shall have emergency lighting with automatic switches for stairs and exits.
[ 1979 ex.s. c 211 s 56.]

catchline: Emergency lighting for facilities housing persons with developmental disabilities.


title: RCW 74.42.570

text:
The facility shall meet state and local laws, rules, regulations, and codes pertaining to health and safety.
[ 1980 c 184 s 14; 1979 ex.s. c 211 s 57.]

catchline: Health and safety requirements.


title: RCW 74.42.580

text:
The department may deny, suspend, revoke, or refuse to renew a license or provisional license, assess monetary penalties of a civil nature, deny payment, seek receivership, order stop placement, appoint temporary management, order emergency closure, or order emergency transfer as provided in RCW 18.51.054 and 18.51.060 for violations of requirements of this chapter or, in the case of medicaid contractors, the requirements of Title XIX of the social security act, as amended, or rules adopted thereunder. Chapter 34.05 RCW shall apply to any such actions, except for receivership, and except that stop placement, appointment of temporary management, emergency closure, emergency transfer, and summary license suspension shall be effective pending any hearing, and except that denial of payment shall be effective pending any hearing when the department determines deficiencies jeopardize the health and safety of the residents or seriously limit the nursing home's capacity to provide adequate care.
[ 1989 c 372 s 13; 1987 c 476 s 27; 1980 c 184 s 15; 1979 ex.s. c 211 s 58.]

catchline: Penalties for violation of standards.


title: RCW 74.42.600

text:
(1) In addition to the inspection required by chapter 18.51 RCW, the department shall inspect the facility for compliance with resident rights and direct care standards of this chapter. The department may inspect any and all other provisions randomly, by exception profiles, or during complaint investigations.
(2) If the facility has not complied with all the requirements of this chapter, the department shall notify the facility in writing that the facility is in noncompliance and describe the reasons for the facility's noncompliance and the department may impose penalties in accordance with RCW 18.51.060.
(3) To avoid unnecessary duplication in inspections, the department shall coordinate with the department of health when inspecting medicaid-certified or medicare-certified, or both, long-term care beds in hospitals for compliance with Title XVIII or XIX of the social security act.
[ 1995 c 282 s 5; 1987 c 476 s 28; 1982 c 120 s 3; 1980 c 184 s 17; 1979 ex.s. c 211 s 60.]

catchline: Department inspections—Notice of noncompliance—Penalties—Coordination with department of health.


title: RCW 74.42.620

text:
The department shall adopt rules pursuant to chapter 34.05 RCW necessary to carry out the policies and provisions of RCW 74.42.010 through 74.42.570. The department shall amend or repeal any rules that are in conflict with RCW 74.42.010 through 74.42.570.
[ 1979 ex.s. c 211 s 62.]

catchline: Departmental rules.


title: RCW 74.42.630

text:
If any part of chapter 184, Laws of 1980 shall be found to be in conflict with federal requirements which are a prescribed condition to the allocation of federal funds to the state, such conflicting part of this act is hereby declared to be inoperative solely to the extent of such conflict, and such finding or determination shall not affect the operation of the remainder of this act; the rules and regulations under this act shall meet federal requirements which are a necessary condition to the receipt of federal funds by the state.
[ 1980 c 184 s 21.]

catchline: Conflict with federal requirements.


title: RCW 74.42.640

text:
(1) To ensure the proper delivery of services and the maintenance and improvement in quality of care through self-review, each facility may maintain a quality assurance committee that, at a minimum, includes:
(a) The director of nursing services;
(b) A physician designated by the facility; and
(c) Three other members from the staff of the facility.
(2) When established, the quality assurance committee shall meet at least quarterly to identify issues that may adversely affect quality of care and services to residents and to develop and implement plans of action to correct identified quality concerns or deficiencies in the quality of care provided to residents.
(3) To promote quality of care through self-review without the fear of reprisal, and to enhance the objectivity of the review process, the department shall not require, and the long-term care ombuds program shall not request, disclosure of any quality assurance committee records or reports, unless the disclosure is related to the committee's compliance with this section, if:
(a) The records or reports are not maintained pursuant to statutory or regulatory mandate; and
(b) The records or reports are created for and collected and maintained by the committee.
(4) The department may request only information related to the quality assurance committee that may be necessary to determine whether a facility has a quality assurance committee and that it is operating in compliance with this section.
(5) Good faith attempts by the committee to identify and correct quality deficiencies shall not be used as a basis for imposing sanctions.
(6) If the facility offers the department documents generated by, or for, the quality assurance committee as evidence of compliance with nursing facility requirements, the documents are protected as quality assurance committee documents under subsections (7) and (9) of this section when in the possession of the department. The department is not liable for an inadvertent disclosure, a disclosure related to a required federal or state audit, or disclosure of documents incorrectly marked as quality assurance committee documents by the facility.
(7) Information and documents, including the analysis of complaints and incident reports, created specifically for, and collected and maintained by, a quality assurance committee are not subject to discovery or introduction into evidence in any civil action, and no person who was in attendance at a meeting of such committee or who participated in the creation, collection, or maintenance of information or documents specifically for the committee shall be permitted or required to testify in any civil action as to the content of such proceedings or the documents and information prepared specifically for the committee. This subsection does not preclude: (a) In any civil action, the discovery of the identity of persons involved in the care that is the basis of the civil action whose involvement was independent of any quality improvement committee activity; and (b) in any civil action, the testimony of any person concerning the facts which form the basis for the institution of such proceedings of which the person had personal knowledge acquired independently of their participation in the quality assurance committee activities.
(8) A quality assurance committee under subsection (1) of this section, RCW 18.20.390, 70.41.200, 4.24.250, or 43.70.510 may share information and documents, including the analysis of complaints and incident reports, created specifically for, and collected and maintained by, the committee, with one or more other quality assurance committees created under subsection (1) of this section, RCW 18.20.390, 70.41.200, 4.24.250, or 43.70.510 for the improvement of the quality of care and services rendered to nursing facility residents. Information and documents disclosed by one quality assurance committee to another quality assurance committee and any information and documents created or maintained as a result of the sharing of information and documents shall not be subject to the discovery process and confidentiality shall be respected as required by subsections (7) and (9) of this section, RCW 18.20.390 (6) and (8), 43.70.510(4), 70.41.200(3), and 4.24.250(1). The privacy protections of chapter 70.02 RCW and the federal health insurance portability and accountability act of 1996 and its implementing regulations apply to the sharing of individually identifiable patient information held by a coordinated quality improvement program. Any rules necessary to implement this section shall meet the requirements of applicable federal and state privacy laws.
(9) Information and documents, including the analysis of complaints and incident reports, created specifically for, and collected and maintained by, a quality assurance committee are exempt from disclosure under chapter 42.56 RCW.
(10) Notwithstanding any records created for the quality assurance committee, the facility shall fully set forth in the resident's records, available to the resident, the department, and others as permitted by law, the facts concerning any incident of injury or loss to the resident, the steps taken by the facility to address the resident's needs, and the resident outcome.
(11) A facility operated as part of a hospital licensed under chapter 70.41 RCW may maintain a quality assurance committee in accordance with this section which shall be subject to the provisions of subsections (1) through (10) of this section or may conduct quality improvement activities for the facility through a quality improvement committee under RCW 70.41.200 which shall be subject to the provisions of RCW 70.41.200(9).
[ 2013 c 23 s 230; 2006 c 209 s 13; 2005 c 33 s 3.]
Notes:
Findings—2005 c 33: See note following RCW 18.20.390.

catchline: Quality assurance committee.


title: RCW 74.42.910

text:
If any part of this act is found to be in conflict with federal requirements which are a prescribed condition to the allocation of federal funds to the state, the conflicting part of this act is hereby declared to be inoperative solely to the extent of the conflict and with respect to the agencies directly affected, and such finding or determination shall not affect the operation of the remainder of this act in its application to the agencies concerned. The rules under this act shall meet federal requirements which are a necessary condition to the receipt of federal funds by the state.
[ 1979 ex.s. c 211 s 70.]

catchline: Construction—Conflict with federal requirements.


title: RCW 74.42.920

text:
Chapter 74.42 RCW shall be suspended immediately, and its effective date delayed so that it shall take effect on January 1, 1981.
[ 1980 c 184 s 19; 1979 ex.s. c 211 s 72.]
Notes:
Effective date—1980 c 184 s 19: "Section 19 of this 1980 act is necessary for the immediate preservation of the public peace, health, and safety, the support of the state government and its existing public institutions, and shall take effect immediately [April 4, 1980]." [ 1980 c 184 s 22.]

catchline: Chapter 74.42 RCW suspended—Effective date delayed until January 1, 1981.


title: RCW 74.46.010

text:
(1) This chapter may be known and cited as the "nursing facility medicaid payment system."
(2) The purposes of this chapter are to set forth principles to guide the nursing facility medicaid payment system and specify the manner by which legislative appropriations for medicaid nursing facility services are to be allocated as payment rates among nursing facilities.
(3) The legislature finds that the medicaid nursing facility rates calculated under this chapter provide sufficient reimbursement to efficient and economically operating facilities and bear a reasonable relationship to costs.
[ 2010 1st sp.s. c 34 s 1; 1998 c 322 s 1; 1980 c 177 s 1.]
Notes:
Effective date—2010 1st sp.s. c 34: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 1, 2010." [ 2010 1st sp.s. c 34 s 23.]

catchline: Short title—Purpose—Finding.


title: RCW 74.46.020

text:
Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
(1) "Appraisal" means the process of estimating the fair market value or reconstructing the historical cost of an asset acquired in a past period as performed by a professionally designated real estate appraiser with no pecuniary interest in the property to be appraised. It includes a systematic, analytic determination and the recording and analyzing of property facts, rights, investments, and values based on a personal inspection and inventory of the property.
(2) "Arm's-length transaction" means a transaction resulting from good-faith bargaining between a buyer and seller who are not related organizations and have adverse positions in the market place. Sales or exchanges of nursing home facilities among two or more parties in which all parties subsequently continue to own one or more of the facilities involved in the transactions shall not be considered as arm's-length transactions for purposes of this chapter. Sale of a nursing home facility which is subsequently leased back to the seller within five years of the date of sale shall not be considered as an arm's-length transaction for purposes of this chapter.
(3) "Assets" means economic resources of the contractor, recognized and measured in conformity with generally accepted accounting principles.
(4) "Audit" or "department audit" means an examination of the records of a nursing facility participating in the medicaid payment system, including but not limited to: The contractor's financial and statistical records, cost reports and all supporting documentation and schedules, receivables, and resident trust funds, to be performed as deemed necessary by the department and according to department rule.
(5) "Capital component" means a fair market rental system that sets a price per nursing facility bed.
(6) "Capitalization" means the recording of an expenditure as an asset.
(7) "Case mix" means a measure of the intensity of care and services needed by the residents of a nursing facility or a group of residents in the facility.
(8) "Case mix index" means a number representing the average case mix of a nursing facility.
(9) "Case mix weight" means a numeric score that identifies the relative resources used by a particular group of a nursing facility's residents.
(10) "Contractor" means a person or entity licensed under chapter 18.51 RCW to operate a medicare and medicaid certified nursing facility, responsible for operational decisions, and contracting with the department to provide services to medicaid recipients residing in the facility.
(11) "Default case" means no initial assessment has been completed for a resident and transmitted to the department by the cut-off date, or an assessment is otherwise past due for the resident, under state and federal requirements.
(12) "Department" means the department of social and health services (DSHS) and its employees.
(13) "Depreciation" means the systematic distribution of the cost or other basis of tangible assets, less salvage, over the estimated useful life of the assets.
(14) "Direct care component" means nursing care and related care provided to nursing facility residents and includes the therapy care component, along with food, laundry, and dietary services of the previous system.
(15) "Direct care supplies" means medical, pharmaceutical, and other supplies required for the direct care of a nursing facility's residents.
(16) "Entity" means an individual, partnership, corporation, limited liability company, or any other association of individuals capable of entering enforceable contracts.
(17) "Equity" means the net book value of all tangible and intangible assets less the recorded value of all liabilities, as recognized and measured in conformity with generally accepted accounting principles.
(18) "Essential community provider" means a facility which is the only nursing facility within a commuting distance radius of at least forty minutes duration, traveling by automobile.
(19) "Facility" or "nursing facility" means a nursing home licensed in accordance with chapter 18.51 RCW, excepting nursing homes certified as institutions for mental diseases, or that portion of a multiservice facility licensed as a nursing home, or that portion of a hospital licensed in accordance with chapter 70.41 RCW which operates as a nursing home.
(20) "Fair market value" means the replacement cost of an asset less observed physical depreciation on the date for which the market value is being determined.
(21) "Financial statements" means statements prepared and presented in conformity with generally accepted accounting principles including, but not limited to, balance sheet, statement of operations, statement of changes in financial position, and related notes.
(22) "Generally accepted accounting principles" means accounting principles approved by the financial accounting standards board (FASB) or its successor.
(23) "Grouper" means a computer software product that groups individual nursing facility residents into case mix classification groups based on specific resident assessment data and computer logic.
(24) "High labor-cost county" means an urban county in which the median allowable facility cost per case mix unit is more than ten percent higher than the median allowable facility cost per case mix unit among all other urban counties, excluding that county.
(25) "Historical cost" means the actual cost incurred in acquiring and preparing an asset for use, including feasibility studies, architect's fees, and engineering studies.
(26) "Home and central office costs" means costs that are incurred in the support and operation of a home and central office. Home and central office costs include centralized services that are performed in support of a nursing facility. The department may exclude from this definition costs that are nonduplicative, documented, ordinary, necessary, and related to the provision of care services to authorized patients.
(27) "Indirect care component" means the elements of administrative expenses, maintenance costs, taxes, and housekeeping services from the previous system.
(28) "Large nonessential community providers" means nonessential community providers with more than sixty licensed beds, regardless of how many beds are set up or in use.
(29) "Lease agreement" means a contract between two parties for the possession and use of real or personal property or assets for a specified period of time in exchange for specified periodic payments. Elimination (due to any cause other than death or divorce) or addition of any party to the contract, expiration, or modification of any lease term in effect on January 1, 1980, or termination of the lease by either party by any means shall constitute a termination of the lease agreement. An extension or renewal of a lease agreement, whether or not pursuant to a renewal provision in the lease agreement, shall be considered a new lease agreement. A strictly formal change in the lease agreement which modifies the method, frequency, or manner in which the lease payments are made, but does not increase the total lease payment obligation of the lessee, shall not be considered modification of a lease term.
(30) "Medical care program" or "medicaid program" means medical assistance, including nursing care, provided under RCW 74.09.500 or authorized state medical care services.
(31) "Medical care recipient," "medicaid recipient," or "recipient" means an individual determined eligible by the department for the services provided under chapter 74.09 RCW.
(32) "Minimum data set" means the overall data component of the resident assessment instrument, indicating the strengths, needs, and preferences of an individual nursing facility resident.
(33) "Net book value" means the historical cost of an asset less accumulated depreciation.
(34) "Net invested funds" means the net book value of tangible fixed assets employed by a contractor to provide services under the medical care program, including land, buildings, and equipment as recognized and measured in conformity with generally accepted accounting principles.
(35) "Nonurban county" means a county which is not located in a metropolitan statistical area as determined and defined by the United States office of management and budget or other appropriate agency or office of the federal government.
(36) "Owner" means a sole proprietor, general or limited partners, members of a limited liability company, and beneficial interest holders of five percent or more of a corporation's outstanding stock.
(37) "Patient day" or "resident day" means a calendar day of care provided to a nursing facility resident, regardless of payment source, which will include the day of admission and exclude the day of discharge; except that, when admission and discharge occur on the same day, one day of care shall be deemed to exist. A "medicaid day" or "recipient day" means a calendar day of care provided to a medicaid recipient determined eligible by the department for services provided under chapter 74.09 RCW, subject to the same conditions regarding admission and discharge applicable to a patient day or resident day of care.
(38) "Patient-driven payment method" means a case mix system implemented by the centers for medicare and medicaid services to classify skilled nursing facility patients into payment groups based on specific data-driven patient characteristics.
(39) "Qualified therapist" means:
(a) A mental health professional as defined by chapter 71.05 RCW;
(b) An intellectual disabilities professional who is a therapist approved by the department who has had specialized training or one year's experience in treating or working with persons with intellectual or developmental disabilities;
(c) A speech pathologist who is eligible for a certificate of clinical competence in speech pathology or who has the equivalent education and clinical experience;
(d) A physical therapist as defined by chapter 18.74 RCW;
(e) An occupational therapist who is a graduate of a program in occupational therapy, or who has the equivalent of such education or training; and
(f) A respiratory care practitioner certified under chapter 18.89 RCW.
(40) "Quality enhancement component" means a rate enhancement offered to facilities that meet or exceed the standard established for the quality measures.
(41) "Rate" or "rate allocation" means the medicaid per-patient-day payment amount for medicaid patients calculated in accordance with the allocation methodology set forth in RCW 74.46.421 through 74.46.531.
(42) "Rebased rate" or "cost-rebased rate" means a facility-specific component rate assigned to a nursing facility for a particular rate period established on desk-reviewed, adjusted costs reported for that facility covering at least six months of a prior calendar year designated as a year to be used for cost-rebasing payment rate allocations under the provisions of this chapter.
(43) "Records" means those data supporting all financial statements and cost reports including, but not limited to, all general and subsidiary ledgers, books of original entry, and transaction documentation, however such data are maintained.
(44) "Resident assessment instrument," including federally approved modifications for use in this state, means a federally mandated, comprehensive nursing facility resident care planning and assessment tool, consisting of the minimum data set and resident assessment protocols.
(45) "Resident assessment protocols" means those components of the resident assessment instrument that use the minimum data set to trigger or flag a resident's potential problems and risk areas.
(46) "Secretary" means the secretary of the department of social and health services.
(47) "Small nonessential community providers" means nonessential community providers with sixty or fewer licensed beds, regardless of how many beds are set up or in use.
(48) "Therapy care" means those services required by a nursing facility resident's comprehensive assessment and plan of care, that are provided by qualified therapists, or support personnel under their supervision, including related costs as designated by the department.
(49) "Title XIX" or "medicaid" means the 1965 amendments to the social security act, P.L. 89-07, as amended and the medicaid program administered by the department.
(50) "Urban county" means a county which is located in a metropolitan statistical area as determined and defined by the United States office of management and budget or other appropriate agency or office of the federal government.
[ 2024 c 246 s 1. Prior: 2016 c 131 s 4; 2010 1st sp.s. c 34 s 2; 2010 c 94 s 29; 2007 c 508 s 7; 2006 c 258 s 1; 2001 1st sp.s. c 8 s 1; 1999 c 353 s 1; 1998 c 322 s 2; 1995 1st sp.s. c 18 s 90; 1993 sp.s. c 13 s 1; 1991 sp.s. c 8 s 11; 1989 c 372 s 17; 1987 c 476 s 6; 1985 c 361 s 16; 1982 c 117 s 1; 1980 c 177 s 2.]
Notes:
Effective date—2010 1st sp.s. c 34: See note following RCW 74.46.010.
Purpose—2010 c 94: See note following RCW 44.04.280.
Effective date—2007 c 508: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 1, 2007." [ 2007 c 508 s 8.]
Effective date—2006 c 258: "This act takes effect July 1, 2006." [ 2006 c 258 s 8.]
Severability—2001 1st sp.s. c 8: "If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected." [ 2001 1st sp.s. c 8 s 21.]
Effective dates—2001 1st sp.s. c 8: "(1) Sections 1 through 19 of this act are necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and take effect July 1, 2001.
(2) Section 20 of this act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect June 29, 2001." [ 2001 1st sp.s. c 8 s 22.]
Effective dates—1999 c 353: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions. Section 11 of this act takes effect immediately [May 17, 1999], and sections 1 through 10 and 12 through 17 take effect July 1, 1999." [ 1999 c 353 s 18.]
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.
Effective date—1993 sp.s. c 13: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect July 1, 1993." [ 1993 sp.s. c 13 s 21.]
Effective date—1991 sp.s. c 8: See note following RCW 18.51.050.
Savings—1985 c 361: "This act shall not be construed as affecting any existing right acquired or any obligation or liability incurred under the statutes amended or repealed by this act or any rule, regulation, or order adopted under those sections, nor as affecting any proceeding instituted under those sections." [ 1985 c 361 s 20.]

catchline: Definitions.


title: RCW 74.46.022

text:
The department shall establish, by rule, the procedures, principles, and conditions for the nursing facility medicaid payment system addressed by the following principles:
(1) The department must receive complete, annual reporting of all costs and the financial condition of each contractor, prepared and presented in a standardized manner. The department shall establish, by rule, due dates, requirements for cost report completion, actions required for improperly completed or late cost reports, fines for any statutory or regulatory noncompliance, retention requirements, and public disclosure requirements.
(2) The department shall examine all cost reports to determine whether the information is correct, complete, and reported in compliance with this chapter, department rules and instructions, and generally accepted accounting principles.
(3) Each contractor must establish and maintain, as a service to the resident, a bookkeeping system incorporated into the business records for all resident funds entrusted to the contractor and received by the contractor for the resident. The department shall adopt rules to ensure that resident personal funds handled by the contractor are maintained by each contractor in a manner that is, at a minimum, consistent with federal requirements.
(4) The department shall have the authority to audit resident trust funds and receivables, at its discretion.
(5) Contractors shall provide the department access to the nursing facility, all financial and statistical records, and all working papers that are in support of the cost report, receivables, and resident trust funds.
(6) The department shall establish a settlement process in order to reconcile medicaid resident days to billed days and medicaid payments for the preceding calendar year. The settlement process shall ensure that any savings in the direct care or therapy care component rates be shifted only between direct care and therapy care component rates, and shall not be shifted into any other rate components.
(7) The department shall define and identify allowable and unallowable costs.
(8) A contractor shall bill the department for care provided to medicaid recipients, and the department shall pay a contractor for service rendered under the facility contract and appropriately billed. Billing and payment procedures shall be specified by rule.
(9) The department shall establish the conditions for participation in the nursing facility medicaid payment system.
(10) The department shall establish procedures and a rate setting methodology for a change of ownership.
(11) The department shall establish, consistent with federal requirements for nursing facilities participating in the medicaid program, an appeals or exception procedure that allows individual nursing home providers an opportunity to receive prompt administrative review of payment rates with respect to such issues as the department deems appropriate.
(12) The department shall have authority to adopt, amend, and rescind such administrative rules and definitions as it deems necessary to carry out the policies and purposes of this chapter.
[ 2010 1st sp.s. c 34 s 19.]
Notes:
Effective date—2010 1st sp.s. c 34: See note following RCW 74.46.010.

catchline: Nursing facility medicaid payment system—Establishing procedures, principles, and conditions.


title: RCW 74.46.024

text:
The department shall establish, by rule, the procedures, principles, and conditions for a pay-for-performance supplemental payment structure that provides payment add-ons for high performing facilities. To the extent that funds are appropriated for this purpose, the pay-for-performance structure will include a one percent reduction in payments to facilities with exceptionally high direct care staff turnover, and a method by which the funding that is not paid to these facilities is then used to provide a supplemental payment to facilities with lower direct care staff turnover.
[ 2010 1st sp.s. c 34 s 20.]
Notes:
Effective date—2010 1st sp.s. c 34: See note following RCW 74.46.010.

catchline: Pay-for-performance supplemental payment structure—Establishing procedures, principles, and conditions.


title: RCW 74.46.421

text:
(1) The purpose of *part E of this chapter is to determine nursing facility medicaid payment rates that, in the aggregate for all participating nursing facilities, are in accordance with the biennial appropriations act.
(2)(a) The department shall use the nursing facility medicaid payment rate methodologies described in this chapter to determine initial component rate allocations for each medicaid nursing facility.
(b) The initial component rate allocations shall be subject to adjustment as provided in this section in order to assure that the statewide average payment rate to nursing facilities is less than or equal to the statewide average payment rate specified in the biennial appropriations act.
(3) Nothing in this chapter shall be construed as creating a legal right or entitlement to any payment that (a) has not been adjusted under this section or (b) would cause the statewide average payment rate to exceed the statewide average payment rate specified in the biennial appropriations act.
(4)(a) The statewide average payment rate for any state fiscal year under the nursing facility payment system, weighted by patient days, shall not exceed the annual statewide weighted average nursing facility payment rate identified for that fiscal year in the biennial appropriations act.
(b) If the department determines that the weighted average nursing facility payment rate calculated in accordance with this chapter is likely to exceed the weighted average nursing facility payment rate identified in the biennial appropriations act, then the department shall adjust all nursing facility payment rates proportional to the amount by which the weighted average rate allocations would otherwise exceed the budgeted rate amount. Any such adjustments for the current fiscal year shall only be made prospectively, not retrospectively, and shall be applied proportionately to each component rate allocation for each facility.
(c) If any final order or final judgment, including a final order or final judgment resulting from an adjudicative proceeding or judicial review permitted by chapter 34.05 RCW, would result in an increase to a nursing facility's payment rate for a prior fiscal year or years, the department shall consider whether the increased rate for that facility would result in the statewide weighted average payment rate for all facilities for such fiscal year or years to be exceeded. If the increased rate would result in the statewide average payment rate for such year or years being exceeded, the department shall increase that nursing facility's payment rate to meet the final order or judgment only to the extent that it does not result in an increase to the statewide weighted average payment rate for all facilities.
[ 2008 c 263 s 1; 2001 1st sp.s. c 8 s 4; 1999 c 353 s 3; 1998 c 322 s 18.]
Notes:
*Reviser's note: Chapter 74.46 RCW was previously divided by parts. Some of the sections that were included in Part E have since been repealed or have expired.
Severability—Effective dates—2001 1st sp.s. c 8: See notes following RCW 74.46.020.
Effective dates—1999 c 353: See note following RCW 74.46.020.

catchline: Purpose of part E—Nursing facility medicaid payment rates.


title: RCW 74.46.441

text:
The department shall disclose to any member of the public all rate-setting information consistent with requirements of state and federal laws.
[ 1998 c 322 s 20.]

catchline: Public disclosure of rate-setting information.


title: RCW 74.46.475

text:
The department shall analyze the submitted cost report or a portion thereof of each contractor for each report period to determine if the information is correct, complete, reported in conformance with department instructions and generally accepted accounting principles, the requirements of this chapter, and such rules as the department may adopt. If the analysis finds that the cost report is incorrect or incomplete, the department may make adjustments to the reported information for purposes of establishing payment rate allocations. A schedule of such adjustments shall be provided to contractors and shall include an explanation for the adjustment and the dollar amount of the adjustment. Adjustments shall be subject to review and appeal as provided in this chapter.
[ 2010 1st sp.s. c 34 s 8; 1998 c 322 s 21; 1985 c 361 s 13; 1983 1st ex.s. c 67 s 23.]
Notes:
Effective date—2010 1st sp.s. c 34: See note following RCW 74.46.010.
Savings—1985 c 361: See note following RCW 74.46.020.
Effective dates—1983 1st ex.s. c 67: "This act is necessary for the immediate preservation of the public peace, health, and safety, the support of the state government and its existing public institutions and shall take effect on July 1, 1983, with the exception of section 28 of this act, which shall take effect on January 1, 1985." [ 1983 1st ex.s. c 67 s 51.]

catchline: Submitted cost report—Analysis and adjustment by department.


title: RCW 74.46.485

text:
(1) The legislature recognizes that staff and resources needed to adequately care for individuals with cognitive or behavioral impairments is not limited to support for activities of daily living. Therefore, the department shall:
(a) Beginning July 1, 2024, implement a method for applying case mix to the rate. This method should be informed by the minimum data set collected by the centers for medicare and medicaid services;
(b) Subject to the availability of amounts appropriated for this specific purpose, employ the case mix adjustment method to adjust rates of individual facilities for case mix changes;
(c) Upon the discontinuation of resource utilization group's scores, and in collaboration with appropriate stakeholders, create a new case mix adjustment method for adjusting direct care rates based on changes in case mix using the patient-driven payment method;
(d) By December 1, 2024, provide an initial report to the governor and appropriate legislative committees outlining a phased implementation plan; and
(e) By December 1, 2026, provide a final report to the appropriate legislative committees. These reports must include the following information:
(i) An analysis of the potential impact of the new case mix classification methodology on nursing facility payment rates;
(ii) Proposed payment adjustments for capturing specific client needs that may not be clearly captured in the data available from the centers for medicare and medicaid services; and
(iii) A plan to continuously monitor the effects of the new methodologies on each facility to ensure certain client populations or needs are not unintentionally negatively impacted.
(2) A default case mix group shall be established for cases in which the resident dies or is discharged for any purpose prior to completion of the resident's initial assessment. The default case mix group and case mix weight for these cases shall be designated by the department.
(3) A default case mix group may also be established for cases in which there is an untimely assessment for the resident. The default case mix group and case mix weight for these cases shall be designated by the department.
[ 2024 c 246 s 2; 2021 c 334 s 991; 2017 c 286 s 1; 2011 1st sp.s. c 7 s 4; 2010 1st sp.s. c 34 s 9; 2009 c 570 s 2; 1998 c 322 s 22.]
Notes:
Conflict with federal requirements—Effective date—2021 c 334: See notes following RCW 43.79.555.
Purpose—Findings—Intent—Severability—Effective date—2011 1st sp.s. c 7: See RCW 74.48.005, 74.48.900, and 74.48.901.
Analysis—2011 1st sp.s. c 7: "(1) For fiscal years 2012 and 2013 and subject to appropriation, the department of social and health services shall do a comparative analysis of the facility-based payment rates calculated on July 1, 2011, using the payment methodology defined in chapter 74.46 RCW as modified by RCW 74.46.431, 74.46.435, 74.46.437, 74.46.485, 74.46.496, 74.46.501, 74.46.506, 74.46.515, and 74.46.521, to the facility-based payment rates in effect June 30, 2010. If the facility-based payment rate calculated on July 1, 2011, is smaller than the facility-based payment rate on June 30, 2011, the difference shall be provided to the individual nursing facilities as an add-on payment per medicaid resident day.
(2) During the comparative analysis performed in subsection (1) of this section, if it is found that the direct care rate for any facility calculated under RCW 74.46.431, 74.46.435, 74.46.437, 74.46.485, 74.46.496, 74.46.501, 74.46.506, 74.46.515, and 74.46.521 is greater than the direct care rate in effect on June 30, 2010, then the facility shall receive a ten percent direct care rate add-on to compensate that facility for taking on more acute clients than they have in the past.
(3) The rate add-ons provided in subsection (2) of this section are subject to the reconciliation and settlement process provided in RCW 74.46.022(6)." [ 2011 1st sp.s. c 7 s 11.]
Effective date—2010 1st sp.s. c 34: See note following RCW 74.46.010.
Effective date—2009 c 570: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately [May 19, 2009]." [ 2009 c 570 s 3.]

catchline: Case mix method implementation.


title: RCW 74.46.496

text:
(1) Each case mix classification group shall be assigned a case mix weight. The case mix weight for each resident of a nursing facility for each calendar quarter or six-month period during a calendar year shall be based on data from resident assessment instruments completed for the resident and weighted by the number of days the resident was in each case mix classification group. Days shall be counted as provided in this section.
(2) The case mix weights shall be based on finalized case mix weights as published by the centers for medicare and medicaid services in the federal register.
[ 2024 c 246 s 3; 2011 1st sp.s. c 7 s 5; 2010 1st sp.s. c 34 s 10; 2006 c 258 s 4; 1998 c 322 s 23.]
Notes:
Purpose—Findings—Intent—Severability—Effective date—2011 1st sp.s. c 7: See RCW 74.48.005, 74.48.900, and 74.48.901.
Analysis—2011 1st sp.s. c 7: See note following RCW 74.46.485.
Effective date—2010 1st sp.s. c 34: See note following RCW 74.46.010.
Effective date—2006 c 258: See note following RCW 74.46.020.

catchline: Case mix weights—Determination.