Washington - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Washington licenses Home Health Agencies through the Department of Health (DOH) under Chapter 246-335 WAC, requiring an initial $5,000 licensing fee and a formal Certificate of Need (CoN) review before operations can begin. The Health Care Authority (HCA) reimburses these agencies through the ProviderOne system for intermittent skilled nursing, physical therapy, and occupational therapy delivered to Apple Health (Medicaid) beneficiaries.

Agencies must secure Medicare certification to enroll as a billing provider with HCA. The approval sequence mandates passing the DOH initial survey, obtaining the CoN, achieving Medicare certification via an accrediting organization or state survey, and executing a Core Provider Agreement with HCA.

1. Service Definition and Scope

Under WAC 246-335-510, home health services in Washington encompass skilled nursing care and specialized therapies delivered in a patient's residence under a physician-ordered plan of care. Apple Health covers these intermittent services to treat acute illnesses or manage chronic conditions, preventing institutionalization.

Agencies must provide services that align with both state licensing standards and federal Medicare conditions of participation to maintain their billing status.

• WAC Citation: Chapter 246-335 WAC Part 3 governs Home Health Agency Services.
• Covered Disciplines: Skilled nursing, physical therapy, occupational therapy, and speech-language pathology.
• Plan of Care: Must be reviewed on-site, updated, approved, and signed by appropriate agency personnel and the client or legal representative every 12 months or upon significant change.
• Supervision: Requires a designated director of clinical services to oversee direct care.

2. Regulatory and Oversight Agencies

The Washington State Department of Health (DOH) handles the licensure and survey of In-Home Services Agencies. The Washington State Health Care Authority (HCA) manages Medicaid enrollment and claims through the ProviderOne system.

The DOH Certificate of Need Program oversees the market entry of new Medicare-certified home health agencies to prevent unnecessary duplication of services.

• Licensing Authority: Washington State Department of Health (https://doh.wa.gov)
• Medicaid Agency: Washington State Health Care Authority (https://www.hca.wa.gov)
• Medicaid Portal: ProviderOne (https://www.waproviderone.org)
• Certificate of Need Program: DOH Certificate of Need Program (https://doh.wa.gov/licenses-permits-and-certificates/facilities-z/certificate-need)

3. Gatekeeping Prerequisites: Who Can Even Apply

Washington imposes a strict Certificate of Need (CoN) requirement for establishing a new Medicare-certified home health agency. Applicants cannot simply apply for a license; they must first prove community need through the DOH CoN program.

Additionally, HCA requires home health agencies to hold Medicare certification to enroll as Apple Health billing providers, meaning agencies must pass federal surveys before billing Medicaid.

• Certificate of Need: Required under WAC 246-310 before establishing a new home health agency or expanding into a new county.
• Medicare Certification: HCA requires home health agencies to be Medicare-certified to enroll as Apple Health billing providers.
• Business License: Must hold a current Washington State Master Business License from the Department of Revenue.
• Organizational Structure: Must submit an organizational chart describing key positions and duties prior to licensure application acceptance.

4. Licensure and Certification Requirements

DOH issues an In-Home Services Agency license with a specific "Home Health" service category designation. The initial license is valid for 12 months, after which agencies transition to a standard 24-month renewal cycle following a successful initial survey.

Agencies may seek deemed status if they are accredited by a DOH-approved national accrediting organization, which can exempt them from routine state licensing surveys.

• Initial Fee: $5,000 for the home health service category under WAC 246-335-990.
• Application Form: DOH In-Home Services Agency License Application.
• Plan of Operation: Must submit a detailed plan including service areas, hours of operation, and a description of services.
• Deemed Status: Agencies accredited by a DOH-approved organization (like ACHC or CHAP) may be granted deemed status.

5. Medicaid Provider Enrollment

Agencies enroll with HCA via the ProviderOne portal as a "Fac/Agncy/Orgn/Inst" billing provider. Enrollment requires an active DOH license, Medicare certification, and a signed Core Provider Agreement.

Providers must ensure their organizational NPI is properly linked to their ProviderOne profile to facilitate electronic claims submission.

• Enrollment System: ProviderOne portal.
• Provider Type: Facility/Agency/Organization/Institution.
• Required Agreement: HCA Core Provider Agreement.
• NPI Requirement: Must obtain and register an organizational National Provider Identifier (NPI) specific to the home health agency.

6. Staffing, Training and Background Checks

WAC 246-335 mandates specific administrative and clinical leadership roles, including an Administrator and a Director of Clinical Services. All personnel with direct patient contact must undergo background checks through the Washington State Patrol.

The Administrator is responsible for ensuring all personnel and contractors hold current Washington state credentials according to their respective practice acts.

• Administrator: Must oversee day-to-day operations, fiscal affairs, and designate an alternate in writing.
• Director of Clinical Services: Must be a registered nurse (RN) responsible for clinical oversight and quality of care.
• Background Checks: Criminal history background checks and disclosure statements must be obtained within three months of the application date.
• Credential Verification: Administrator must ensure all personnel and contractors are currently credentialed by the state of Washington.

7. Documentation, Policies and Records

Home health agencies must maintain comprehensive policies aligned with WAC 246-335-525 and federal Medicare conditions of participation. Patient records must document all clinical interventions, physician orders, and care plan updates.

Agencies must also implement a formal quality improvement program to monitor patient outcomes and agency compliance.

• Policy Alignment: Policies and procedures may only reference federal Medicare requirements or accrediting organization requirements if the agency is Medicare-certified or accredited.
• Bill of Rights: Must provide clients with a written bill of rights under WAC 246-335-535.
• Care Plan Documentation: Must include client name, consent for services, and detailed documentation of services provided.
• Quality Improvement: Must implement a quality improvement program as specified in WAC 246-335-555.

8. Billing, Rates and Claims

HCA reimburses home health services on a fee-for-service basis using standard HCPCS and CPT codes, or through managed care organization (MCO) contracts for clients enrolled in Apple Health managed care. Claims are submitted electronically via ProviderOne.

Certain specialized therapies or extended nursing visits may require prior authorization through the ProviderOne system before services are rendered.

• Billing System: ProviderOne for fee-for-service claims.
• Prior Authorization: Certain therapies and extended nursing visits require prior authorization through ProviderOne.
• Fee Schedule: Rates are published in the HCA Home Health Services Billing Guide and Fee Schedule.
• Managed Care: Agencies must contract separately with Apple Health MCOs to bill for managed care enrollees.

9. Approval Sequence and Timeline

The pathway to becoming a billing provider is lengthy due to the CoN and Medicare certification processes. Agencies must sequence their applications carefully, starting with the CoN before applying for the DOH license.

Once licensed and certified, the final step is completing the ProviderOne enrollment, which HCA typically processes within 30 to 60 days of receipt.

• Step 1: Obtain Certificate of Need approval from DOH.
• Step 2: Submit DOH In-Home Services Agency application and $5,000 fee.
• Step 3: Pass DOH initial licensing survey to receive the 12-month initial license.
• Step 4: Achieve Medicare certification via state survey or accrediting body.
• Step 5: Submit ProviderOne enrollment application to HCA.

10. Common Denials and Survey Findings

DOH issues a statement of deficiencies if an agency fails to meet WAC 246-335 standards during a survey. Agencies must submit a directed plan of correction within specified timeframes to avoid enforcement actions.

Failure to maintain current physician orders or allowing background checks to lapse are frequent triggers for survey citations.

• Care Plan Lapses: Failure to update the physician-ordered plan of care every 12 months or upon significant change.
• Background Check Delays: Allowing staff to provide direct care before completing the Washington State Patrol background check.
• Policy Deficiencies: Submitting generic policies that do not align with Washington's specific WAC 246-335 requirements.
• Unapproved Expansion: Expanding service areas without submitting an amended application and receiving DOH approval.

11. Key Contacts and Resources

Providers should utilize the official DOH and HCA portals for the most current forms, billing guides, and regulatory updates. The HCA Support portal is the primary contact for ProviderOne enrollment issues.

For questions regarding the Certificate of Need process, providers must contact the DOH CoN program directly.

• DOH In-Home Services Licensing: https://doh.wa.gov/licenses-permits-and-certificates/facilities-z/home-care-home-health-and-hospice-agencies
• HCA Provider Enrollment: https://www.hca.wa.gov/billers-providers-partners/become-apple-health-provider/enroll-provider
• ProviderOne Portal: https://www.waproviderone.org
• HCA Support Portal: https://support.hca.wa.gov/hcasupport

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