HCBS - Residential Support Waiver Renewal

The Centers for Medicare and Medicaid (CMS) approved the renewal application for the Residential Support Waiver (RSW), WA.1086, on September 29, 2023. With the approved renewal application, the state is allowed to continue to provide RSW services to eligible persons. The RSW renewal is effective January 1, 2024 through December 31, 2028.

As an important element of Washington State's commitment to provide community alternatives to institutional care, the RSW began in 2014 and provides supports and services in licensed and contracted community residential settings (Adult Family Homes, Assisted Living Facilities, and Enhanced Services Facilities) to adults who are eligible for nursing facility level of care and have personal care and behavioral support needs. Services available in the waiver include:

  • Adult Day Health
  • Behavior Support
  • Client Support Training/Wellness Education
  • Nurse Delegation
  • Personal Care Services
  • Skilled Nursing
  • Specialized Medical Equipment and Supplies

Changes to the RSW in the renewal application include:

  • Updated maximum number of participants authorized to be served in the waiver each year.
  • Addition of a new provider type, Assistive Technology Professional, to the Client Support Training/Wellness Education service.
  • Revision of Performance Measures.
  • Inclusion of Institutes for Mental Disease (IMD) and Inpatient Behavioral Health Agencies as eligible locations ALTSA will pay for retainer payments.
  • Addition of Assisted Living Facility as a provider type for the Community Stability Supports (CSS) service.
  • Removal of reserve capacity.

For more information, read the approval letter from CMS.

Questions? Please contact:

Anne Moua, anne.moua@dshs.wa.gov