May 29 2026 | Timeline For Change in Cost of Care and Services
There are regulatory requirements outlining formal notification to residents and their surrogate decision makers, specifically to charges for care and services. This article outlines the different timelines, depending on the type of service changes.
UPON ADMISSION AND AT LEAST EVERY 24 MONTHS THEREAFTER
RCW 70.129.030 states that the facility must inform the resident or resident representative before admission and at least every 24 months thereafter of services, items, and activities available in or arranged by the facility, and charges for those services, items, and activities. You’ll also want to include charges for services, items, and activities not covered by the applicable public benefits programs (for residents on the Medicaid program) and the facility’s per diem rate (for privately paying residents); often these services include the hair salon, special ticketed items in the greater community, etc.
This notice of charges is typically imbedded into the admission agreement, often added as an addendum that outlines costs associated with each service, level, point system, or similar.
THIRTY DAYS’ WRITTEN NOTICE
According to RCW 70.129.030, each resident and resident representative must be informed in writing at least 30 days in advance of changes in availability or charges for services, items, or activities. While this section of RCW allows for emergencies to offer less than 30 days’ written notice, there is no explanation of what an emergency might entail.
Of note, the 30 days’ written notice of change in charges for services, items, or activities pertains to the entirety of the facility resident population and is not referring to one resident who requires additional care and services. For example, if the facility opts to raise the cost of care across the board – for example, a “point” or “level” going from $100 to $120 – this 30-day written notice to all residents would apply. Similarly (and likely more commonly), a 30-day written notice is required when the facility increases monthly rent for residents.
IMMEDIATE CHANGE IN COST OF CARE
When a resident’s condition changes, and these changes are documented and lead to an increase in the cost of care, the facility must update the resident’s negotiated services agreement (NSA) to reflect the resident’s current care and service needs. The resident must be informed of the charges resulting from the change in service. The facility may begin charging the resident for those additional services as soon as the resident or representative and the assisted living facility mutually agree to the changes or updates to the NSA.
It is imperative that the cost of care is clearly outlined in the facility’s admission agreement/agreement addendum that was signed by the resident or representative at move-in and every 24 months thereafter. If the facility’s admission agreement allows the facility to do so, and if the amended or updated NSA is in place, the facility may retroactively charge for the provision of the new or additional services in accordance with the terms of the admission agreement.
This “immediate change in cost of care” allowance is provided in a Dear Provider Letter, dated September 15, 2017 and listed as “current” on the DSHS website.
For questions about this topic or other assisted living topics, please email Vicki McNealley or call 360-352-3304 extension 107.
