Updates to Bed Hold Policy and DSHS Form 05-249

Home and Community Services (HCS) and the Developmental Disabilities Administration (DDA) issued updates to the Bed Hold policy for clients receiving services through the Residential Support Waiver (RSW) program. The updates also include revisions to DSHS Form 05-249, Notice of Bed Hold.

These changes are intended to clarify approved settings for Bed Hold authorizations and ensure consistent application of policy across residential provider types, while improving the accuracy and usability of the updated form. 

Background

Clients receiving services under the Residential Support Waiver (RSW) often experience short-term stays in settings such as skilled nursing facilities and hospitals. The RSW program has been updated to include additional facility types where clients may receive short-term care, while still allowing providers to receive Bed Hold payments when appropriate.

As a result of these updates, DSHS Form 05-249 has been revised and renamed to reflect the updated Bed Hold policy and reporting structure.

What’s New, Changed, or Clarified

The Bed Hold policy has been updated and divided into two sections:

• One section for clients on MPC, CFC, and CFC+COPES, with no policy changes
• One section for clients on the Residential Support Waiver (RSW), including clients residing in an Enhanced Services Facility (ESF)

DSHS Form 05-249 has also been updated and renamed to align with these changes. Revisions include:

• Name change from “Adult Residential Care Services Notice of Change Form” to “Notice of Bed Hold”
• Removal of Section I (Type of Action)
• Addition of Section I (Facility Name Reporting the Change)
• Removal of Section II (Transfer/Discharge Information)
• Addition of Section II (Type of Action), including:
  
  • Bed Hold for clients receiving MPC, CFC, or CFC+COPES
  • Bed Hold for clients receiving Residential Support Waiver services
• Removal of Sections III and IV
• Addition of Instructions for Completing DSHS 05-249

Providers will be informed via Dear Provider Letter that the updated form is available for optional use.

Action

Effective immediately for clients on the Residential Support Waiver program, case managers will use the updated Bed Hold policy when approving and authorizing Bed Holds. These clients may receive short-term care in a:

• Skilled nursing facility
• Hospital
• Institute for Mental Disease (IMD)
• Inpatient behavioral health agency

An Institute for Mental Disease (IMD) is defined as a hospital, nursing facility, or other institution with more than 16 beds, regardless of licensure, that is primarily engaged in providing diagnosis, treatment, or care for individuals with mental diseases, including substance use disorders.

Additional guidance on IMD definitions is available on the Health Care Authority Behavioral Health webpage.

Updated Bed Hold Policy for Residential Support Waiver (RSW) Clients

The client must be receiving RSW services in one of the following approved settings:

• Enhanced Services Facility (ESF)
• Adult Family Home with Specialized Behavior Support (SBS) or Expanded Community Services (ECS)
• Enhanced Adult Residential Care with ECS or Community Stability Supports (CSS)
• Assisted Living Facility with ECS or CSS

Residential facilities are required to hold a client’s bed for up to 20 days when the client requires short-term medical care in a qualifying setting (skilled nursing facility, hospital, IMD, or inpatient behavioral health agency).

A Medicaid client must be in the qualifying care setting for longer than 24 hours before a Bed Hold may be authorized.

If a client returns to the residential setting and is later transferred again to a qualifying care setting, the client must be back in the residential setting for at least 24 hours before a new 20-day Bed Hold period may begin. Otherwise, the original Bed Hold period continues.

Recommended Steps for Providers

Providers are encouraged to:

• Review updated Bed Hold policy requirements for RSW clients
• Ensure staff understand qualifying settings and authorization rules
• Update procedures to reflect the 24-hour return requirement between Bed Hold periods
• Familiarize themselves with revisions to DSHS Form 05-249
• Maintain accurate documentation to support Bed Hold authorizations and reporting

These updates are effective immediately and are intended to improve consistency in Bed Hold authorization and administrative processes across residential settings.