New DSHS Nurse Delegation Policy: What It Means When Your Resident Is in the Hospital
DSHS has issued a new Home and Community Services (HCS) / Developmental Disabilities Administration (DDA) Management Bulletin (H26‑023) that changes how nurse delegation services are authorized and paid when a client is in a hospital or skilled nursing facility (SNF).
This bulletin does not create new regulatory requirements for adult family homes, but it does clarify how nurse delegation can continue during an institutional stay to better support discharge and the resident’s safe return to your home.
What changed
- HCS and DDA now have a specific internal process to authorize nurse delegation service code H2014 U5 when a client is in an institutional setting such as a hospital or nursing facility.
- These nurse delegation services in the hospital/SNF will be paid with state‑only or Roads to Community Living (RCL) funding using appropriate RAC codes (such as 3490, 3930, 3100, 3701) and a new reason code “Hospital‑SNF 99Y000.”
- Case managers will “split” nurse delegation authorization lines in CARE so that units used before, during, and after the hospital stay are clearly separated and do not exceed the 100‑unit monthly limit while the client is institutionalized.
Why this matters to adult family homes
Many AFH residents receive nurse delegation for medications and treatments in your home, and delegators are often key partners during hospitalizations and discharge planning.
Under this new process:
- The nurse delegator can be authorized and paid to assess the resident and complete delegation‑related activities while the resident is in the hospital/SNF, when needed to support transition back to the AFH.
- HCS/DDA no longer need to end the client’s waiver RAC during the hospital stay in order to authorize nurse delegation activity around discharge planning.
- The internal billing error that typically appears when delegation is authorized without community personal care (#30115: “Nurse Delegation services can only be authorized with certain other service.”) will be handled and “forced” by the HCLA Nurse Delegation Program Manager or DDA payment staff so providers can be paid appropriately.
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