Application Types - Washington State Department of Social ...



NH Application Types

Initial License

This application is used for any facility that does not have a current nursing home license. Examples include but are not limited to: (1) a building currently under construction that will be used as a licensed nursing home; or (2) a building previously used as a nursing home, not currently licensed as a nursing home, but will be reopened as a licensed nursing home.

Change of Ownership "Long"

This application is used when an applicant who does not hold a current State of Washington nursing home license wants to become the licensed operator of a currently licensed nursing home. It would not be used by an affiliate of an entity holding a current State of Washington nursing home license even if the applicant is a newly formed entity.

This application is also used when the change of licensee transaction is so complicated that used of the Change of Ownership “Abbreviated” application would provide insufficient information.

Change of Ownership "Abbreviated"

This application is used when an entity that already holds a current State of Washington nursing home license or an "affiliated entity" of an entity already licensed in Washington wants to become the licensed operator of a currently licensed nursing home. An “affiliated entity” is an entity that is owned by, holds interest in, or is a subsidiary of an entity that hold a current State of Washington nursing home license or licenses.

Refer to Change of Ownership “Short” (below) for an additional use of this application.

Change of Ownership "Short"

This application is used when an entity holding a current State of Washington nursing home license wants to become the licensed operator of multiple nursing facilities at the same time. For example, a currently licensed entity (Entity A) wants to operate five (5) facilities currently licensed to Entity B. Entity A would submit one (1) Change of Ownership “Abbreviated” application and four (4) Change of Ownership “Short” applications.

This application is also used when a current licensee wants to change its entity type. For example, the current licensee is a partnership and for financing reasons, needs to change to a limited liability company (LLC) without any change in underlying ownership or control.

This application is used when there are minor changes in the underlying ownership of the current licensee. For example, the current licensee is a partnership with the four partners owning 40%, 30%, 20%, and 10%. The 10% partner wants to leave the partnership and sell all 10% to the 20% partner. A “short” application is submitted.

Certification for a Medicaid Contract

This application is used by a nursing home licensed but not Medicaid certified, wants to apply for Medicaid certification. If the nursing home is not currently Medicare certified, the applicant must simultaneously apply for Medicare certification using the CMS-855A form. The CMS-855A form is available from the Fiscal Intermediary.

Nursing Home Conversion

This application is used by a currently licensed nursing home that will convert all or part of the nursing home to a licensed assisted living facility. The application is considered an assisted living facility application and is found at .

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