April 30 2026 | Medicaid Pre-Admission Assessments and Intermittent Nursing Services

WHCA staff have received questions from members regarding the use of a potential resident’s Medicaid assessment (called a CARE assessment by DSHS) as the pre-admission assessment.

WAC 388-78A does not acknowledge the idea that the Medicaid CARE assessment can be used as a preadmission assessment; in fact, WAC 388-78A-2060 states the assisted living must conduct the preadmission assessment. In addition, there are concerns that the CARE assessment contents do not fully address WAC 388-78A-2060 preadmission assessment contents, and therefore the assisted living facility must employ or contract with a qualified assessor to conduct these assessments.

In addition, if the prospective resident will need intermittent nursing services, an RN must conduct that portion of the preadmission assessment; the facility therefore must employ or contract with an RN for that portion of the assessment.

For some assisted living operators who contract with an RN to conduct preadmission assessments on behalf of the facility, oftentimes these RNs also complete assessments in other care settings. This might be a source of confusion, given the fact that adult family home regulations state that the home “must obtain a written assessment” (as opposed to the assisted living regulations stating the facility must conduct the assessment). Furthermore, the adult family home regulations call out the DSHS case manager as a qualifying person to complete the resident assessment; therefore the CARE assessment in the adult family home sector can indeed serve as the home’s preadmission assessment.

It is imperative, then, for assisted livings that opt to contract out intermittent nursing services, to ensure those RN contractors fully grasp the assisted living regulations as they relate to intermittent nursing services, including nursing assessments, negotiated service agreements, nursing care, nurse delegation, and medication administration.

WHCA has met with DSHS regarding the assessment discrepancies between assisted living and adult family home settings, and the added costs for assisted livings, specifically associated with employing or contracting with a qualified assessor to complete a resident’s preadmission assessment when the CARE assessment should suffice. Our recommendations included:

• Adding a line in WAC 388-78A-2060 that states the DSHS CARE assessment, conducted by a DSHS case manager, can serve as the facility’s preadmission assessment in its entirety; and/or
• Changing the word “conduct” to “obtain” for an assessment to be completed, both preadmission and ongoing.

Please note, neither of these changes have taken place.

As an assisted living operator, please be aware of the regulatory differences between and among care settings, to ensure that you are meeting the assisted living regulations as published.

For questions about assisted living, please email Vicki McNealley or call 360.352.3304 extension 107.