Information for Adult Family Home Providers

Announcements

New Rules effective Jan. 1, 2026, to comply with federal Home and Community Based Settings requirements.

The rules require AFH, ALF, and ESF to have a “residency agreement” with residents who have Medicaid as a payor. The purpose of the agreement is to provide resident protections for eviction and appeals comparable to the Residential Landlord Tenant Act. AFH, ALF, and ESF must also provide written notice to Medicaid residents of their right to legal assistance when issuing a notice of transfer or discharge.

Find the provider letter, slide deck presentation, Q & A, and FAQ here.
Optional forms available for use on Jan. 1, 2026:
- HCLA Residency Agreement Language Template (DSHS 16-302).
- Notice of Transfer or Discharge (DSHS 15-458). The form can be used for all residents. Distribution of the form to the Long-term Care Ombuds and DSHS case manager is required only for residents with Medicaid:
  - DSHS case manager: Use your established methods to send the Notice of Transfer or Discharge.
  - Long-Term Care Ombuds: Email the Notice of Transfer or Discharge to Discharges@mschelps.org or send by e-fax (253) 216-3699.
The long-term care discharge defense screening line phone number is (888) 437-0017. You must include it in any discharge notice to a resident with Medicaid. This number must also be included in your residency agreement.
Find more information about this and other RCS rulemaking projects here ALTSA RCS Rulemaking | DSHS (page updates in progress, check back regularly).

AFH License Application Process Informational Slideshow

Reporting Abuse and Neglect in Adult Family Homes Webinar (May 7, 2024 Recording)

AFH online license application note: Certain symbols can cause errors or prevent submission of the completed application. Do not use the following symbols &, =, +, or #. Instead, use the following terms: (and) (equals) (plus) (number sign), spelling out the words, with parentheses on either side. See the updated Instructions for the license application for details. We are researching a permanent fix to this issue and will advise you of any changes.

Background checks during and after licensure:

For new license applications
For change of ownership

If you have any questions regarding the adult family home application process, please contact the Business Analysis and Applications Unit at baau@dshs.wa.gov. If you have general questions about opening an AFH, please reach out to Resource Support and Development at resourcedevelopment@dshs.wa.gov.

Adult Family Home (Region 1 only) Online Incident Report Document Uploads

Adult family homes can upload PDF (portable document format) documents to the Online Incident Report portal for initial mandatory reporting and five working days follow-up reporting for facility-reported incidents*. The department added document-upload functions to the initial mandatory-reporting and follow-up-reporting screens. Provide as much information as possible at the time of reporting and uploading. Do not upload and submit background check documents. File names must be unique. Individual file size is 5MB, and overall upload is 15 MB. DSHS Community Program “Exhibit 359” Follow-Up Investigation Report is a recommended document to upload for follow-up reports. Below is the link. The Department formatted the exhibit so providers can download them, enter information, and upload into OIR at the time of reporting. Save the exhibit and any other documents uploaded as PDFs.

Links: Exhibit 359 Form - 27-275 Upload Guide

* Follow up reporting is done for the purpose of the “proof of concept” FRI pilot. Facility-reported incidents are the same as mandatory reports

Quick Links

Provider Letters and Rule Changes

Do my caregivers need the Home Care Aide certification?

Yes, they will have to be Home Care Aide certified unless they meet one of the following exemptions:

RNs, LPNs, and certified nursing assistants (NA- C/CNA) or persons in an approved CNA training program.
Medicare certified home health aides.
Person with special education training and an endorsement granted by the Superintendent of Public Instruction.
Employed as a LTC worker sometime between 1/1/2011 and 1/6/2012 AND who completed the training requirements in effect at the time. Must have proof of that employment meeting the requirements of DOH WAC 246-980-070. Long-Term Care Employment Verification form (DOH 675-006)

Forms