Feb 20 2026 | State of Washington SNF Enforcement Remedies: An Overview

When a skilled nursing facility (SNF) in Washington gets an enforcement notice from the Department of Social and Health Services (DSHS) or the Centers for Medicare & Medicaid Services (CMS), it can feel overwhelming and confusing. Here is what it really means in straightforward terms.

In Washington, DSHS has the legal authority granted by the state legislature under RCW 18.51 to license, inspect, and investigate SNFs. If a facility does not follow state rules and requirements, DSHS has the power to take enforcement action.

When a facility becomes licensed by DSHS, the licensee agrees to always follow all applicable laws and regulations. If the facility falls out of compliance, DSHS can step in. Some penalties are required by law, while others are optional depending on the situation.

Here are the main remedies DSHS can use:

• Stop Placement: The facility cannot admit new residents and under some circumstances readmit residents.
• Emergency Closure or Transfer (Revocation/Summary Suspension): Residents may be moved, and the facility could close immediately if there’s serious danger.
• Civil Fines: Monetary penalties.
• Temporary Management: The state appoints someone to run the facility.
• Receivership: Control of the facility is assigned legally to another party.
• License Actions: Denial, suspension, revocation, or refusal to renew the license.
• Denial of Payment for New Medicaid Admissions: The facility will not be paid for new Medicaid residents.
• Termination of Medicaid Contract: The provider’s agreement can be ended.
• On-Site Monitoring: State oversight of the facility related to issues that prompted enforcement action.
• Conditions on the License: Extra requirements, such as staff training, help writing a correction plan, or proof of financial stability. This can vary depending on the reason the facility is out of compliance with the regulations.

These actions are separate from any federal penalties CMS may impose.

Under Washington rules, DSHS must issue a stop placement order when a facility is not in “substantial compliance” and the problems:

• Put residents’ health or safety at risk, or
• Seriously limit the facility’s ability to provide proper care.

If the facility is Medicaid certified, the state must also deny Medicaid payment for new admissions in certain situations. If the facility is Medicare certified (or both Medicare and Medicaid), it may also face federal payment denials.

Under WAC 388-97-4220, DSHS must deny, suspend, revoke, or refuse to renew a license in certain circumstances. In short, serious or ongoing noncompliance can directly threaten a facility’s ability to operate.

Under WAC 388-97-4480, DSHS must consider additional penalties when a facility has:

• A history of failing to stay in compliance.
• Serious deficiencies.
• Failed to submit an acceptable plan of correction.
• Problems in general administration or nursing services.
• Retaliated against a resident or employee for whistleblower activity.
• Discriminated against Medicare or Medicaid residents.
• Interfered with a long-term care ombudsman’s official duty.

DSHS can also consider other relevant factors when deciding what penalties to impose.

When choosing remedies, DSHS looks at:

• Whether problems remain uncorrected.
• Whether the same issues keep happening.
• Whether the deficiencies are widespread.
• Whether residents’ health, safety, or welfare are at risk.

In summary, it is important to remember that each deficiency is treated separately and that the following can apply:

• Each violation can result in its own penalty.
• Each day a violation continues can count as a separate violation.

• DSHS has clear authority to regulate and impose enforce penalties for licensed facilities.
• Some penalties are mandatory when residents are at risk.
• Optional penalties become more likely with repeat or serious violations.
• State enforcement actions are separate from federal CMS penalties.
• Each violation and even each day it continues can trigger additional consequences.

If your facility receives an enforcement notice, it is important to review it carefully. If you have questions, contact Elena Madrid at (360) 352-3305, extension 105 or email.