Enhanced Services Facilities


RCS Reimplementation Webinar

Safe Start for AFH-ALF-ESF  (October 7, 2021)

Latest Guidance Regarding COVID-19

See provider letters for the latest guidance from the department regarding COVID-19.  Additional resources are available on the ALTSA and DOH web pages to assist long-term and residential care facilities in response to the COVID-19 outbreak. See also CDC Recommendations for COVID-19 in Healthcare Settings

COVID-19 Information for new LTC Providers

COVID-19 Vaccine Information for Newly Licensed Long-Term Care Providers

The Washington State Legislature authorized DSHS to develop Enhanced Services Facilities (ESFs) under Chapter 70.97 RCW. This new category of licensed residential facility will provide a community placement option for individuals whose complicated personal care and behavioral challenges do not rise to a level that requires an institutional setting. Individuals are referred to an ESF if they are coming out of state and community psychiatric hospitals or have no other placement option due to their complex behavior, medical, chemical dependency and/or mental health needs.

ESFs use high staffing ratios, with a strong focus on behavioral interventions, to offer effective services to their residents. These facilities offer behavioral health, personal care services and nursing, at a level of intensity that is not generally provided in other licensed long-term care settings.

Information and Updates

ESF Information Changes (DSHS 10-602)

How to become a licensed and contracted ESF Provider

In order to serve ESF residents, you must be a licensed ESF provider and be contracted with the Home and Community Services (HCS) Division.

Successful ESF applicants will have experience providing personal care to Medicaid clients with highly complex personal care and behavioral challenges.

If you are interested in becoming a licensed ESF, Residential Care Services (RCS) and HCS will meet with you to outline the process and provide ongoing assistance as you develop your plan for licensing.

Step 1: Request an information meeting by contacting HCS Residential Support Program Manager Sandy Spiegelberg, (360) 725-2576 or sandra.spiegelberg@dshs.wa.gov

Step 2: Work with HCS and RCS to develop building and operational plans.

Step 3: Continue working with HCS and RCS to begin the application process with Department of Health, Construction Review Services (CRS).

Next steps will depend on building design, local permitting process and program elements.  As you move forward, you will need to:

  1. Read and understand the licensing regulations, Chapter 388-107 WAC.
  2. Ensure the building meets all requirements in Chapter 388-107 WAC, by working with the Department of Health's Construction Review Services to comply with all building specifications.
  3. Submit the completed ESF license application and the license fee of $1,040 per bed.
  4. Work with RCS' licensors to comply with all requirements to obtain a license.
  5. Once licensed, submit an ESF contract application (available soon) to provide services to DSHS clients.

Contract Qualifications

In order to receive an ESF Contract to serve DSHS clients, the Contractor must provide evidence of all requirements listed below.

  1. The Contractor must have a current Enhanced Services Facility (ESF) license.
  2. The Contractor must have demonstrated experience and ability providing services and supports in a community based setting to adults with complex behavioral and personal care needs.
  3. The Contractor must have a demonstrated ability to provide (or arrange) for all required staff trainings.

Stakeholder Materials

Statute and Draft Regulations

  • ESF Rule Filings
    • Proposed Rulemaking – Chapter 388-107 WAC (Background Checks)
    • CR 101 – Proposed Rulemaking – Chapter 388-107 WAC (TB)

Questions and Comments

For questions about the ESF Program, please contact Sandy Spiegelberg.

For questions about licensing and the licensing WACs, please contact Sondra Silverman.