June 13, 2013_NH "Dear Administrator"

June 13, 2013


ALTSA:  NH #2013-011

Dear Nursing Facility/Home Administrator

The purpose of this letter is to inform you about some upcoming changes to the RCS Quality Assurance Nurse (QAN) Program.  The QAN Program has been present exclusively in Washington state nursing homes (NH) since 1992.  QAN visits have often resulted in positive outcomes for residents by helping to identify systems at risk of producing care delivery or quality-of-life issues.

Currently, there are eighteen QANs which are geographically dispersed across existing RCS work units statewide.  Under Medicaid authority, QANs:

  • Visit an assigned caseload of NHs on a quarterly basis.
  • Provide on-site utilization review, quality assurance assessment and monitoring, and case-mix accuracy review (CMAR) for Medicaid payment
  • Provide regulation-based technical assistance to NHs through the use of clinically-focused protocols.

Effective July 8, 2013:

  • QANs will focus only on mandatory CMAR work related to the NH Medicaid payment system.
  • Thirteen of the eighteen QAN positions will be moved to full-time NH survey/investigation work and will no longer function in the QAN role.
  • The five remaining QANs will be exclusively focused on CMAR.  CMAR will be managed from RCS headquarters, rather than under District Field Managers.  QAN assignments & coverage areas are yet to be determined.

Federal statute and federal performance standards require NH inspection intervals to be no greater than 15 months, with a statewide average of twelve months.  The addition of QANs who are QIS trained will assist in meeting this mandate. 

This represents a major transition in focus for the QAN program.  We welcome your feedback and questions as we continue to identify issues that need to be addressed related to this transition.


Joyce Pashley Stockwell, Director
Residential Care Services