# WAC 388-97-0100: WAC 388-97-0100. Utilization review

> Washington · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0100

## Section

- **Citation:** WAC 388-97-0100
- **Heading:** WAC 388-97-0100. Utilization review
- **Jurisdiction:** Washington
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Washington Administrative Code / Title 388 / Chapter 388-97 / Section 388-97-0100

## Text

(1) To assure appropriate use of medicaid services, the nursing facility must determine whether each medicaid resident's health has improved sufficiently so the resident no longer needs nursing facility care.
(a) The nursing facility must base its determination on:
(i) An accurate, comprehensive assessment process; and
(ii) Documentation by the resident's physician.
(b) The nursing facility is not responsible to assess under WAC 388-97-1960 , PASSR level II screening assessment.
(2) When the nursing facility determines a resident no longer needs nursing facility care under subsection (1) of this section, the nursing facility must initiate transfer or discharge in accordance with WAC 388-97-0120 , 388-97-0140 , and 42 C.F.R. § 483.12, or successor laws, unless the resident voluntarily chooses to transfer or discharge.
(3) When a nursing facility initiates a transfer or discharge of a medicaid recipient under subsection (2) of this section:
(a) The resident will be ineligible for medicaid nursing facility payment:
(i) Thirty days after the receipt of written notice of transfer or discharge; or
(ii) If the resident appeals the facility determination, thirty days after the final order is entered upholding the nursing home's decision to transfer or discharge a resident.
(b) The department's home and community services may grant extension of a resident's medicaid nursing facility payment after the time specified in subsection (3)(a) of this section, when the department's home and community services staff determine:
(i) The nursing facility is making a good faith effort to relocate the resident; and
(ii) A location appropriate to the resident's medical and other needs is not available.
(4) Department designees may review any assessment or determination made by a nursing facility of a resident's need for nursing facility care.

## Nearby sections

- [WAC 388-97-0001 WAC 388-97-0001. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0001.md)
- [WAC 388-97-0020 WAC 388-97-0020. Nursing facility care](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0020.md)
- [WAC 388-97-0040 WAC 388-97-0040. Discrimination prohibited](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0040.md)
- [WAC 388-97-0060 WAC 388-97-0060. Nursing facility admission and payment requirements](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0060.md)
- [WAC 388-97-0080 WAC 388-97-0080. Discharge planning](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0080.md)
- [WAC 388-97-0100 WAC 388-97-0100. Utilization review](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0100.md)
- [WAC 388-97-0120 WAC 388-97-0120. Individual transfer and discharge rights and procedures](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0120.md)
- [WAC 388-97-0140 WAC 388-97-0140. Transfer and discharge appeals for resident in medicare or medicaid certified facilities](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0140.md)
- [WAC 388-97-0160 WAC 388-97-0160. Discharge or leave of a nursing facility resident](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0160.md)
- [WAC 388-97-0180 WAC 388-97-0180. Resident rights](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0180.md)
- [WAC 388-97-0200 WAC 388-97-0200. Free choice](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0200.md)
- [WAC 388-97-0220 WAC 388-97-0220. Statute implemented in resident decision making, informed consent, and advance directives](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0220.md)
- [WAC 388-97-0240 WAC 388-97-0240. Resident decision making](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0240.md)
- [WAC 388-97-0260 WAC 388-97-0260. Informed consent](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0260.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_388_97_0100. Check the current official text before relying on it. Not legal advice.