Updates to the Bed Hold Policy for Residential Support Waiver Clients

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 expand approved setting types where clients may receive short-term care while allowing residential providers to continue receiving Bed Hold payments.

As part of these changes, DSHS Form 05-249 has been updated and renamed from the “Adult Residential Care Services Notice of Change Form” to the “Notice of Bed Hold.”

Bed Hold Policy for Residential Support Waiver Clients

The updated Bed Hold policy now includes a separate section specific to clients receiving Residential Support Waiver services, including those residing in an Enhanced Services Facility (ESF). Existing Bed Hold policies for clients receiving MPC, CFC, and CFC+COPES services remain unchanged.

Under the revised policy, residential facilities are required to hold a client’s bed for up to 20 days when the client requires short-term care for medical reasons in a:

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

A Medicaid client’s stay in one of these settings must exceed 24 hours before a Bed Hold may be authorized.

If a client returns to the residential setting and is later transferred again for short-term care, the client must remain 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.

Approved Residential Settings Under the RSW Program

The updated policy applies to clients receiving Residential Support Waiver services in the following 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

Updates to DSHS Form 05-249

DSHS Form 05-249 has been revised to reflect the updated Bed Hold policy and provider reporting requirements. Revisions to the form include:

• Renaming the form to “Notice of Bed Hold”
• Adding a section for Facility Name Reporting the Change
• Adding separate Bed Hold sections for:
  • Clients receiving MPC, CFC, or CFC+COPES services
  • Clients receiving Residential Support Waiver services
• Adding instructions for completing DSHS 05-249

Several sections related to transfer and discharge information were also removed as part of the revision process.

What is an Institute for Mental Disease (IMD)

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

Recommended Steps for AFH Providers

In light of the updated Bed Hold policy, providers are encouraged to:

• Review the revised Bed Hold requirements for clients receiving Residential Support Waiver services
• Ensure staff understand when Bed Hold authorizations may apply
• Familiarize themselves with the updated DSHS 05-249 Notice of Bed Hold form
• Review internal procedures related to medical leave tracking and Bed Hold timelines
• Monitor client transitions carefully to ensure compliance with 24-hour return requirements between medical leave periods

The updated Bed Hold policy is effective immediately for clients receiving Residential Support Waiver services.