AGING AND DISABILITY SERVICES ADMINISTRATION
Revised Nursing Home Applications
As part of Residential Care Services’ (RCS) continuing effort to improve customer service and streamline the nursing home license application process, the nursing home license applications and the application packet materials have been revised.
See related letter to providers.
Note : All application materials are in Word format. A free viewer for Word documents is available.
APPLICATION PACKETS
The following types of application packets are downloadable, in full, by clicking on the corresponding link.
- Initial License (39 pages)
- Change of Ownership (CHOW) – “Long” (47 pages)
- Change of Ownership (CHOW) – “Short” (36 pages)
- Change of Ownership (CHOW) – “Abbreviated” (46 pages)
- Medicaid Contract (37 pages)
Not sure which type of application you need? See application types.
RELATED MATERIALS
Download the following individual forms or informational handouts by clicking on the corresponding link:
- Information for Medicaid Contractors Regarding Liability Insurance (PDF Format)
- Background Authorization (2 pages)
- Lease or Operating Agreement Attestation (4 pages)
- Management Agreement Attestation (4 pages)
- NH Frequently Asked Questions (6 pages)
- Resource Information for Licensed Nursing Home Providers (3 pages)
- RCS Regional Contacts (1 page)
If you are unable to view these documents online or require materials in hard copy format, please contact the Residential Care Services Business and Applications Analysis Unit at (360) 725-2420.
If you have difficulty printing these documents, please read the Print Troubleshooting Guide.
