On June 3 2016, the Washington State Department of Social and Health Services (DSHS) and the Centers for Medicare & Medicaid Services (CMS) agreed to a 13-month systems improvement agreement (SIA) to allow Western State Hospital (WSH) the time and guidance to fix systemic operating problems and put more focus on patient treatment and overall safety. In signing the SIA, CMS rescinded its planned termination of WSH’s Medicaid and Medicare participation. CMS is allowed to re-issue the termination if WSH fails to progress toward full compliance with the Medicare Conditions of Participation. The SIA calls for the . . .