Running a Licensed Adult Family Home: Questions & Answers

Not always. Washington requires at least one qualified caregiver in the home whenever residents are there, but also enough staff to meet each resident's needs, and minimum presence does not mean adequate staffing. One caregiver may be unable to safely help several residents who need transfers, toileting, meals, medications or evacuation help at the same time. Base the schedule on actual resident needs, the home's layout, caregiver skills, appointments, nighttime needs and foreseeable emergencies.

Not as informal labor. Anyone who provides care, has unsupervised access, or fills another regulated role may be subject to background-check, training, credential, documentation and employment requirements, and good intentions do not replace qualifications. The guide also warns against a schedule that depends on the provider never being sick, tired or unavailable; build reliable backup coverage with qualified people instead.

It depends on the check. The Washington name and date-of-birth check is valid for two years and must be kept current, while the national fingerprint check is valid indefinitely. Background checks were the fifth most-cited adult family home rule in DSHS's October to December 2024 list, with 101 citations, so track expiration dates and keep each check in the staff member's personnel file.

Plan for it before it happens. A dependable staffing system includes a reliable call-out and backup-coverage process, clear on-call authority, written responsibilities for every shift, resident-specific orientation before anyone works alone, and tracking of training expiration dates. The guide warns that a home without reliable backup coverage is one unexpected event away from a serious problem, and suggests testing the call-out process when you take over a home.

In each staff member's personnel file. Washington requires the file to hold the required records, such as background checks, training and certification, and personnel records were the sixth most-cited AFH rule in DSHS's October to December 2024 list, with 94 citations. The operator guide adds tracking training expiration dates, resident-specific orientation before anyone works alone, and watching caregivers perform resident-specific tasks when you take over a home.

Each staff member's file must hold the required records, such as background checks, training and certification (WAC 388-76-10198). Personnel records and background checks were both among the ten rules DSHS cited most often in adult family homes in October to December 2024. The Washington name and date-of-birth check is valid for two years and must be kept current. Track training expiration dates, and audit every personnel file when you take over a home.

Go file by file. Each staff member's file must hold the required records, such as background checks, training and certification; personnel records were among DSHS's ten most-cited rules in October to December 2024. Confirm each Washington background check is current, Home Care Aide certification is on track (365 days from hire, or 425 with a provisional certificate, for applicants through 2027), 12 continuing education hours are done by each birthday, and specialty training matches the residents served.

Washington requires an up-to-date daily medication log for every resident except those assessed as medication-independent with self-administration. It records every medication, dose, time, the staff member's initials, refusals, and any change with its written verification. For a change, the log shows a call requesting written verification and a copy of that verification from the practitioner. The medication log was among DSHS's ten most-cited rules in October to December 2024.

Stop and resolve it first. When an order, label, discharge instruction or medication log does not match, resolve it with the prescriber, pharmacy, nurse or other authorized professional. Do not change a medication schedule, crush a medication, borrow medication from another resident, or act on an unclear instruction without proper authorization and verification. Each staff member's tasks must match their training and legal authority, and medication changes should be reviewed after hospital returns.

Two things changed on September 20, 2026. The resident record must now include a copy of the notice of rights and services the resident received, with the resident's acknowledgement, and a Social Security number is no longer a required entry. Records must still hold enough information to provide needed care and services, stay confidential, and be available as required. Resident record content was among DSHS's ten most-cited rules in October to December 2024.

Not by backfilling or guessing. Never document care that was not personally completed or reliably verified, do not copy yesterday's note when the resident's condition may have changed, and do not alter a record to make a task look as if it happened at a different time. Late entries and corrections should follow an established, transparent procedure. If something was missed, address the resident's needs, notify the right people, document honestly and fix the system.

Check that the task matches the caregiver's training and legal authority, and treat medication management as a high-risk process. Delegated nursing tasks need nurse delegation: a registered nurse's authorization for a trained caregiver to perform a specific task for a specific resident. The caregiver must be a certified Home Care Aide or Nursing Assistant Certified with core delegation training, plus diabetes training before giving insulin. Keep nurse-delegation documentation and each resident's daily medication log current.

Be careful. A policy is not automatically appropriate because it applies to everyone. Blanket restrictions on visitors, food, schedules, communication or movement may conflict with individual rights and care needs. The home is the residents' home: support reasonable choices in meals, clothing, activities, schedules and visitors, make complaint procedures easy to use, and keep resident money separate from provider funds.

Yes. Since January 1, 2026, every Medicaid resident must have a signed written residency agreement, completed at admission, that commits the home to the transfer and discharge requirements of chapter 70.129 RCW and tells the resident about free legal assistance. A new agreement is needed if a resident moves from private pay back to Medicaid. The rule was amended again on April 30, 2026, so check that your agreements and notices match the current version.

Only after a careful admission decision. First decide whether the home can meet the person's assessed needs with its current staffing, training, layout, equipment and resident mix. Review the current assessment, ask what has changed, speak with the resident, representative, case manager and discharge planner, and put services, rates, responsibilities and limitations in writing. Do not let a hospital's preferred discharge date, a referral source's urgency or an empty bed replace that decision.

No. Train staff to protect the resident, get emergency help when needed, preserve relevant information, and make required reports without waiting for permission from someone who is unavailable. Reporting a concern is not the same as proving exactly what happened, and delayed reporting can increase the risk to residents and add regulatory consequences. For an immediate emergency, call 911; concerns involving vulnerable adults can also be reported to DSHS.

Only if the home can meet that person's assessed needs with its current staffing, training, layout, equipment and resident mix. Weigh elopement risk, nighttime behaviors and supervision needs, and compatibility with current residents. If the needs are dementia-related, the provider, entity representative and resident manager need dementia specialty training before admitting, and caregivers need it too. Your emergency plan should cover a missing or wandering resident. Put services, rates and limitations in writing first.

Washington requires a written emergency and disaster plan covering emergencies that may reasonably occur at the home, what staff and residents do during and after one, and the fire-drill evacuation plan, and staff must be trained on it. A useful plan also covers power, heat or water failure, earthquakes, a missing resident, staffing shortages, medication refrigeration and relocation, and reflects each resident's mobility, cognition, communication and nighttime needs.

Yes. Washington requires every adult family home to keep a written plan for how the home will keep meeting the licensing rules and caring for residents if the provider or entity representative cannot fulfill their duties, and to make it available to DSHS on request. A good plan names who has temporary authority, how staffing and payroll continue, how residents and DSHS are notified, and where licenses and records are kept. Review it whenever people, ownership, banking or insurance change.

No. Gross revenue is not owner income. Six occupied beds at an attractive rate leave out caregiver wages, payroll taxes, overtime and relief coverage, food and supplies, insurance, licensing and training, repairs and equipment, vacancies, debt service or rent, and pay for your own caregiving and management time. Prepare conservative projections showing what happens if the home opens slowly, loses a resident, needs more nighttime staffing or faces a major repair.

Keep an operating reserve and model several scenarios rather than spending as though every occupied bed is permanent. The guide suggests testing one vacant bed for three months, a caregiver wage increase, additional awake-night coverage, a major appliance, roof, plumbing or accessibility repair, a delayed reimbursement, and a resident whose needs increase faster than the payment rate. Track revenue by resident and payer source monthly, and keep separate business accounts and accurate books.

Focus on reliable systems rather than rapid expansion. Review every assessment and negotiated care plan and confirm actual care matches them. Audit personnel files, training, credentials and background checks, and test the call-out process. Reconcile medication orders, supplies and logs. Walk every exit, test alarms and review drill records. Set up separate banking and bookkeeping, review insurance, calculate the actual cost of each occupied bed, and build a cash-flow forecast and reserve.

Income drops much faster than costs. Each resident adds a full year of rate while adding little to costs, because the house, license, insurance and base staff are already paid for, so losing residents removes revenue while most costs stay. Payments tied to a resident, such as a CBHS tier, leave with them. Keep an operating reserve and test scenarios such as one vacant bed for three months; occupancy also decides whether a lender approves a loan.

Resident by resident, by payment system. The Medicaid base rate follows each resident's CARE classification and county and is reassessed as needs change; a CBHS tier is paid on top for qualifying residents and reviewed at least every 12 months; ECS and SBS are owner-held contracts; private-pay levels are set by the home. Count only beds with a Medicaid resident today, since a Medicaid contract alone is not income, and leave Meaningful Day out.

It depends on what is left after costs, not on revenue. Gross revenue is not owner income: full beds still have to cover caregiver wages, payroll taxes, overtime, food and supplies, insurance, licensing, repairs, vacancies, debt service or rent, and pay for your own caregiving and management time. Caregiver wages alone often take a large share of what residents pay, so strong revenue can still leave little. Prepare conservative projections before committing.

They include caregiver wages, payroll taxes, overtime and relief coverage; food, continence and cleaning supplies, and utilities; insurance, licensing, training, professional fees and transportation; repairs and equipment; referral and marketing costs; and debt service or rent. Budget for vacancies, higher staffing as residents' needs change, and pay for your own caregiving and management time. The annual license fee has been $450 per licensed bed since July 2025.

Know the home's financial position every month, not just at tax time. At a minimum: revenue by resident and payer source, accounts receivable and unpaid balances, payroll and overtime, food and household costs, insurance and professional fees, property costs and debt service, maintenance reserves, referral costs, occupancy and vacancy trends, the cost of added care, taxes and licensing, and owner pay versus profit. Keep separate business accounts and accurate books.

Each year in the month the home was first licensed. If it is not paid when due, DSHS imposes remedies, and the license annual fee was the second most-cited adult family home rule in DSHS's October to December 2024 list, with 140 citations. The fee is $450 per licensed bed a year since July 2025, which is $2,700 for six beds, per DSHS in writing.

Possibly. DSHS licensors make unannounced inspections at least every 18 months, with a statewide average of 15 months. A home with no citations on its last three inspections, and no violations from complaint investigations in that time, may go up to two years (RCW 70.128.070). Because visits are unpredictable, providers must stay in continuous compliance rather than prepare only when an inspection seems due.

Anyone can: residents, families or staff. A complaint-based inspection is triggered when someone files a concern with DSHS, and these can range from minor administrative issues to serious safety incidents. They are in addition to routine inspections. Complaints go to DSHS Residential Care Services online or through the toll-free Complaint Resolution Unit at 1-800-562-6078.

In DSHS's most recent published list, for October to December 2024, the medication system rule was cited most (WAC 388-76-10430, 179 citations), followed by the license annual fee, notice of resident rights and services, medical devices, background checks, personnel records, evacuation drills, safety and maintenance, resident record content, and the medication log. Most are record-keeping problems that a consistent documentation system prevents.

Only with the right steps. Devices that carry a safety risk, such as bed rails, cannot be used as a restraint or for staff convenience, and need an assessment, informed consent, and a place in the care plan first. This medical devices rule was the fourth most-cited adult family home rule in DSHS's October to December 2024 list, with 106 citations.

Build self-auditing into normal operations. Set a recurring review schedule for assessments and negotiated care plans, medication records, caregiver qualifications and training, background checks, emergency drills, incident and mandatory-reporting documentation, water temperature, food storage, bedrooms, exits and alarms, required notices, and insurance and business records. DSHS publishes tables of the rules most often cited in inspections, which show where homes most often go wrong.

Yes. Each home must keep its last three years of inspection reports available to anyone who asks (RCW 70.128.080). DSHS says its online Locator shows limits and enforcement issued within the previous three years. Because a change of ownership brings a new license, a previous owner's record may not follow the address.

A routine inspection is DSHS's unannounced review of the whole home, at least every 18 months, or up to two years after three clean inspections in a row: care, documentation, staffing and safety, with inspectors reviewing records, interviewing staff and residents and observing daily operations. A complaint investigation is triggered when someone, whether a resident, family member or staff, files a concern with DSHS, and comes on top of routine visits. Complaints range from minor administrative issues to serious safety incidents.

Track the annual license fee, due each year in the month the home was first licensed; each Washington background check, valid two years; 12 hours of continuing education for providers, resident managers and certified caregivers, due by each person's birthday; current CPR and first aid cards; and partial evacuation drills at least every two months, with a full drill each year. Add recurring reviews of care plans, medication records, training, required notices, and insurance and business records.

It means the home cannot admit new residents until violations are corrected and stability is demonstrated. DSHS uses it when there is significant risk if admissions continue. It is the third step on the enforcement ladder, after license conditions and civil fines and before license suspension or revocation. Civil fines and stop-placement orders are reserved for higher-risk situations; most citations require correction rather than severe penalties.

Under RCW 70.128.160, civil fines are at least $100 per day per violation, up to $3,000 per incident, and up to $10,000 for a current or former provider operating an unlicensed home. By law, fines become more severe for violations that are repeated, uncorrected, widespread, or a threat to residents.

Treat it as a real fix, not a writing exercise. Protect the resident first, make any required reports, begin correcting, and document the response. A real correction addresses what happened, which residents may have been affected, what was corrected immediately, what system will prevent it happening again, and how you will monitor compliance. For lower-level or first-time violations, DSHS can set license conditions, and the home may continue operating while corrections are made.

A citation, or deficiency, means DSHS found a licensing rule was not met; it does not by itself mean a resident was harmed, and most citations require correction rather than severe penalties. Enforcement is DSHS's response when violations call for more, in proportion to their severity: license conditions, civil fines, a stop placement that suspends admissions, or suspension or revocation of the license.

Within 10 calendar days, the home returns a signed attestation of correction stating that it has corrected or will correct each deficiency by a date DSHS approves. The home also keeps its own plan of correction and must show it to DSHS on request (WAC 388-76-10930, as amended September 20, 2026). A real correction records what happened, what was corrected immediately, what system will prevent a repeat, and how compliance will be monitored.

Usually a required correction, not a severe penalty. DSHS responds in proportion to severity, along a ladder: license conditions the home corrects within a set time while it keeps operating, then civil fines, then a stop placement on new admissions, and finally suspension or revocation for severe, repeated or uncorrected violations. After an inspection report, the home returns a signed attestation of correction within 10 calendar days.

Protect any affected resident first and make any required reports. Then return a signed attestation of correction within 10 calendar days, stating that you have corrected or will correct each deficiency by a date DSHS approves. Keep your own plan of correction, since DSHS can ask to see it. A real correction covers what happened, who was affected, what was fixed immediately, what system prevents a repeat, and how you will monitor it.

A DSHS case manager completes a CARE assessment; the home does not set the price. CARE weighs cognitive performance, clinical complexity, mood and behavior, activities of daily living, and exceptional care criteria. It places the person in a group first, working from the highest group down, then assigns a sub-level from the ADL or behavior score. The result is one of seventeen classifications, which, together with the county, sets the daily rate.

It depends on the resident's classification. For rates effective July 1, 2026, the base adult family home rate in King, Pierce and Snohomish counties runs from $144.47 to $279.30 per day; in all other Washington counties it runs from $132.49 to $250.61. For example, D Med-High pays $225.32 in those three counties. These are base rates only, without add-ons, and they change each July 1 and sometimes January 1.

Not automatically. Higher rates are not free money: a D or E resident requires more staff time, more skill, and often more overnight coverage, so look at revenue and staffing cost together. Classifications also move, since residents are reassessed and a rate can go down as well as up. Income that depends on one or two high-classification residents is more fragile than the same income spread across six.

Within a group, the ADL score generally sets the sub-level. In Group C, High is an ADL score of 25 to 28, Medium-High is 18 to 24, and Medium is 9 to 17. Group C means clinically complex without significant cognitive impairment. At the base rates effective July 1, 2026, C High pays $200.91 per day in King, Pierce and Snohomish counties and $181.93 in all other Washington counties.

They are the five groups in DSHS's CARE assessment, split into 17 classifications from A Low to E High. Group E is exceptional care; D is clinical complexity with significant cognitive impairment; C is clinical complexity without it; B is qualifying mood and behavior needs; A is everyone else. They are not a ladder residents climb. The classification, together with the county, sets the daily Medicaid rate the home is paid for that resident.

For Medicaid residents, yes. Homes in King, Pierce and Snohomish counties are paid more than homes in the rest of the state. At rates effective July 1, 2026, the base daily rate runs from $144.47 to $279.30 in those three counties and from $132.49 to $250.61 elsewhere, depending on each resident's classification. Private-pay rates are set by each home, and no agency publishes them.

Mostly through Medicaid. A DSHS case manager's CARE assessment places each Medicaid resident in one of 17 classifications, from A Low to E High, and the classification and rate region set the daily rate. Some residents also qualify for Community Behavioral Health Support, paid in six tiers, and some homes hold owner-level ECS or SBS contracts. Private-pay rates are set by each home. Billing Medicaid requires a signed Medicaid contract first.

Treat it as both a care question and a payment question. Staff should know how to respond to significant changes in condition, which can be reportable, and staffing may need to increase, or the home may not be able to meet future needs. Medicaid residents are reassessed, including when their condition changes significantly, and the rate can go down as well as up. Talk with the resident's representative promptly rather than letting confusion grow.

No. Tier 3 pays $194.81 a day, about $71,100 a year, but it authorizes 6.1 to 10 hours a day of one-on-one staffing that has to actually be provided. At eight hours a day, that works out to about $24.35 per staffed hour before payroll taxes and overhead. The rates come from the 2025-27 collective bargaining agreement, in effect through June 30, 2027. Look at the payroll supporting the income, not just the deposits.

A daily log. To use Medicaid dollars, the Health Care Authority and managed care organizations need to verify that services were provided, so providers keep a log of supportive supervision for each day of service. Industry guidance is that the average hours delivered each month should line up with the resident's authorized tier. Eligibility is reviewed at least once every 12 months, and a resident who stabilizes may be moved to a lower tier.

Licensed adult family homes can provide CBHS as agency-contracted providers. A home enrolls through ProviderOne so that the Health Care Authority and the managed care organizations can contract with it, and it must contract with the managed care organizations to serve their enrollees. CBHS is administered by the Health Care Authority in conjunction with DSHS and began July 1, 2024, replacing the older BHPC wrap-around funding.

IBSS, Intensive Behavioral Supportive Supervision, is a managed-care alternative route to the same supportive supervision service as CBHS. The same tier and rate table applies to it. A resident has one or the other, never both, so they cannot be stacked for the same person.

No. For care plans from eligibility assessments on or after July 1, 2025, a resident must first be found not eligible for CBHS before receiving Specialized Behavior Support (SBS) under the Residential Support Waiver, so the two do not stack. That makes CBHS the state's primary route for paying behavioral support in an adult family home.

Expanded Community Services (ECS) is not an add-on: the home is paid the ECS daily rate ($256.87) or the resident's base rate, whichever is greater. Specialized Behavior Support (SBS) is an add-on of $178.00 a day on top of the base rate, for six to eight additional hours a day of individualized staffing. Both amounts come from the 2025-27 collective bargaining agreement. The home must qualify for and hold these contracts, and since July 1, 2025 a resident must first be found not eligible for CBHS before receiving SBS.

No. You may still see Meaningful Day listed alongside ECS and SBS, including on state pages, but the 2025 state budget eliminated its funding. DSHS contracting staff confirmed in September 2026 that Meaningful Day has not been available since July 1, 2025, so it should not be counted as income.

Yes. No agency sets private-pay care levels. Many homes price private-pay residents as a base monthly rate plus a care-level charge, often labeled Level 1 through 5, and each home defines its own levels and amounts in its admission agreement. Levels are reviewed whenever the home reassesses, and they are a business decision the next owner can change.

First, whether your home can be paid. For CBHS, the home enrolls through ProviderOne and must contract with the resident's managed care plan. SBS needs the home's own contract and an approved staffing calendar, and a home may generally serve up to three SBS residents at a time. Second, whether you can staff it: the add-on pays for staff time that must actually be provided and logged daily. Tiers are reviewed at least every 12 months, and the income leaves with the resident.

No. ECS and SBS are contracts the home itself must qualify for and hold, with its own fully executed contract in place before providing or billing for those services. DSHS asks for a current Medicaid contract held at least 12 months (one DSHS manual says 12 months licensed), no significant enforcement in the last year, and contract training completed first. SBS also needs a demonstrated history with challenging behavior and an approved staffing calendar.

Yes, if it is set out in writing first. No agency sets private-pay care levels; each home defines its own levels and amounts in its admission agreement. Before admission, explain in writing which services the base rate includes, the charges for additional care or services, who supplies items like continence products and transportation, and how changing needs and rates are handled. Medicaid residents follow stricter rules on extra charges.

No. A license lets you operate; it does not let you bill Medicaid. A home needs a signed Medicaid contract with DSHS, and DSHS says contractors cannot admit new Medicaid clients until that contract is in place. A licensed home requests one by emailing the DSHS Contracts Unit at adshqcontracts@dshs.wa.gov with the home's name, license number and address. Each resident's services must also be authorized by their DSHS case manager.

DSHS lists the Contractor Intake Form (DSHS 27-043), an "Additional Details AFH" form, the Medicaid Provider Disclosure Statement and a W-9. After you sign and return the contract, DSHS sends back the fully signed copy with your ProviderOne number, and HCA emails ProviderOne login instructions. If they do not arrive within 24 hours, call HCA at 1-800-562-3022.

ProviderOne pays weekly. HCA says a claim submitted by Tuesday at 5 p.m. Pacific should pay that Friday at the earliest or the following Monday at the latest; a claim entered after the deadline pays Friday of the next week. Holidays and system maintenance can move these dates. A remittance advice listing paid, denied and pending claims is posted each Friday.

Not automatically. HCA sets new social service providers up for paper checks (warrants) by default. To be paid by direct deposit you sign up separately for electronic funds transfer (EFT) in ProviderOne.

Not usually. DSHS does not pay for the last day of service when a client moves out, except when the last day is the date of death. Payment for part of a month is prorated. When a resident moves out, DSHS guidance says to refund any unspent participation within 30 days.

The home does. DSHS financial staff set the amount (client responsibility: room and board, plus participation toward care for waiver residents), and ProviderOne subtracts it from your claim automatically. HCA says the provider must still collect that amount from the resident each month. The Medicaid payment plus the resident's share is payment in full for the services in the resident's plan.

Only with the training. A home must not admit or keep a resident with dementia, mental illness or developmental disability needs unless the provider, entity representative, resident manager and staff have completed the specialty training. The one window: if a resident who already lives in the home develops one of these needs, the provider, entity representative and resident manager have 120 days to finish the training. It does not apply to admitting someone who already has the need.

ECS (Expanded Community Services) covers personal care, 24-hour on-site support, medication management and behavior support, and does not offer one-on-one staffing. SBS (Specialized Behavior Support) adds six to eight hours a day of individualized staff time, needs an approved staffing calendar before it is authorized, and is limited to three SBS residents at a time (four with the HCS Regional Administrator's approval). For SBS, a resident must first be found not eligible for CBHS.

Through ProviderOne, once two things are in place: a signed DSHS Medicaid contract and a service authorization from the resident's case manager. Claims can be entered directly, from saved or batch templates, or uploaded through a clearinghouse, and must be filed within 12 months of the service date. ProviderOne pays weekly and subtracts the resident's client responsibility, which you collect from the resident yourself.

Use the remittance advice ProviderOne posts each Friday, which lists paid, denied, adjusted and in-process claims, and match it to each resident's authorization. Expect each payment to be the authorized rate minus the resident's client responsibility, which ProviderOne deducts and you collect from the resident. Check each resident's client responsibility in ProviderOne before you bill, and know revenue by resident and payer source every month.

Check three things. First, client responsibility: ProviderOne subtracts the resident's share from your claim, and you collect it from the resident. Second, the dates: part months are prorated, and DSHS does not pay the last day when a resident moves out, except the date of death. Third, the authorization: if it shows Error or Canceled, contact the case manager before providing or billing. Billing questions go to HCA at 1-800-562-3022; authorization questions go to the case manager.

Mainly training and paperwork. The provider, entity representative, resident manager and staff must complete dementia specialty training before the home admits a resident with those needs, and the provider, entity representative and resident manager pass the DSHS competency test. Then you ask DSHS for the designation on the AFH Information Change form (DSHS 10-585), with proof of the training. The rules do not attach a payment rate to a designation.

It depends on the problem. Authorization questions go to the resident's case manager, and if an authorization shows Error or Canceled you must contact the case manager before providing or billing for services. Billing questions go to HCA at 1-800-562-3022. Check the weekly remittance advice, posted each Friday, for denied or adjusted claims; claims must be filed within 12 months of the service date. If a resident stops paying their share, email the case manager promptly.

In ProviderOne, on the Social Service Authorization List, which shows each authorization with the case manager's name and email. DSHS pays only for authorized services, and it tells case managers the authorization should be complete before the client is admitted, so confirm with the case manager that it is active before each Medicaid admission. If an authorization shows Error or Canceled, contact the case manager before providing or billing for services.

Check the resident's service authorization. DSHS pays only for authorized services, which the case manager authorizes based on the CARE assessment; each one appears in ProviderOne on the Social Service Authorization List. The Medicaid payment plus the resident's share is payment in full for services in the service plan. Extra charges are allowed only for items the rate does not cover, under a written supplemental payment policy given to residents first, with each payment recorded and the case manager notified.

Treat them as two payments. ProviderOne automatically deducts the resident's client responsibility from your claim, and you collect that amount from the resident each month. Check each resident's amount in ProviderOne before you bill and whenever DSHS says it changed, and set up a simple monthly process for collecting each share. ProviderOne deducts it whether or not the resident pays, so if a payment is missed, email the case manager promptly.

Generally, yes. The rules require a qualified person to live in the home: the owner, or a resident manager when the owner does not live there, who is responsible for residents' care at all times. The one exception: no one has to live in the home if it has staff 24 hours a day and someone who can make decisions is always present (WAC 388-76-10040). A resident manager can be designated for only one home at a time.

Anyone serving as resident manager must meet the resident-manager qualifications, which include 1,000 hours of direct care within the past 60 months (WAC 388-76-10130). That applies even when a management company places the person in the home. The licensed owner keeps ultimate responsibility for all personnel issues (WAC 388-76-11060), so the owner must stay in charge of who is placed there. A resident manager can be designated for only one home at a time.

A second license needs 24 months on the first with no enforcement actions for significant violations; later licenses need 12 months since the last one (WAC 388-76-10037). Owning several homes yourself is a separate path from hiring a management company. A company can manage several homes under written agreements, but each licensed owner stays responsible for the home and its residents, meets with the manager monthly and visits at least quarterly, and each home needs its own on-site person in charge.

Ask whether they file the management agreement and form DSHS 27-226 with DSHS 60 days before starting; who will be the on-site person in charge and who employs them; what bond or insurance covers residents' money; what they report monthly; how many homes they manage; and what happens to staff and records if the agreement ends. Hiring a manager does not hand over the license: you stay responsible for the home and residents, meet with the manager monthly and visit at least quarterly.

Hiring a manager does not hand over the license or the responsibility. The licensed owner keeps ultimate responsibility for daily operations and residents' care, services and safety; for personnel, staffing plans and staff training; for monthly oversight meetings and on-site visits at least quarterly; for appointing the entity representative; and for signing license applications. If you give the manager so much that you no longer run the home day to day, DSHS treats it as a change of ownership (WAC 388-76-11055).

The provider is the individual or entity DSHS licenses to operate the home, and the license is valid only for that provider and address. A resident manager is a qualified person the provider employs or contracts with to live in the home when the provider or entity representative does not. A resident manager can run the home day to day and must meet the same experience rules, including 1,000 hours of direct care, but the provider stays the licensee and remains responsible.

The company can recruit and schedule staff and run payroll as your agent, if the written agreement assigns that work. But every agreement must leave you, the licensed owner, with ultimate responsibility for personnel, staffing plans and staff training. Whether the management company may itself be the resident manager's employer is not spelled out in the rules, so ask DSHS before setting it up that way; either way, you must stay in charge of who is placed in the home.

Yes, as your agent, if the written agreement assigns it: recruiting and scheduling staff and running payroll are typical. But the agreement must leave you, the licensed owner, with ultimate responsibility for personnel, staffing plans and staff training, and you still meet with the manager monthly and visit at least quarterly. If you hand over so much that you no longer run the home day to day, DSHS treats it as a change of ownership.

An adult family home needs general and professional liability, property, workers' compensation for caregivers, and often abuse-and-molestation coverage. A buyer cannot take over the seller's policies, so coverage has to be placed before the change-of-ownership date. Look for an agent who writes adult family homes or assisted living, not just homeowners policies, knows which carriers will bind care-home risk in Washington, and can quote before closing. See Find a Professional.

Yes. Independent consultants and former DSHS licensors can do pre-inspection walkthroughs to find compliance gaps before an official DSHS inspection, and can help with corrective action plans, record-keeping systems and staff training compliance. Look for a DSHS inspection or licensing background, current knowledge of WAC 388-76, pre-inspection audit services and corrective action plan support. See Find a Professional.