Washington - Integrated Employment — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Washington funds Integrated Employment—officially termed Individual Supported Employment—through the Department of Social and Health Services (DSHS) Developmental Disabilities Administration (DDA) Basic Plus, Core, and Community Protection waivers. Providers must secure a contract with the local county developmental disabilities program where they intend to operate before the state will process a Medicaid enrollment application.

The service delivers job development, placement, and on-site coaching to help individuals achieve competitive, prevailing-wage work in community settings. Approval requires passing a county-level Request for Qualifications (RFQ) or open enrollment review, executing a county subcontract, and subsequently enrolling in the Washington State Health Care Authority's (HCA) ProviderOne MMIS system as a non-medical HCBS provider.

1. Service Definition and Scope

Individual Supported Employment in Washington provides tailored job development, placement, and retention supports to DDA waiver participants. The goal is sustained, competitive employment at or above minimum wage in integrated community settings.

Services are individualized and include intake, discovery, job preparation, employer negotiation, and on-the-job coaching. Group Supported Employment is a distinct service and is being phased out in favor of individualized, competitive models.

• Target Population: Adults aged 21 and older enrolled in DDA waivers who have an employment goal in their Person-Centered Service Plan.
• Service Phases: Includes Discovery, Job Preparation, Job Placement, and Job Retention/Coaching.
• Setting Requirements: Must occur in integrated community businesses alongside non-disabled coworkers, complying with the HCBS Settings Rule.
• Wage Standard: Participants must be paid at or above the Washington State minimum wage or the local prevailing wage for the position.
• Excluded Activities: Cannot be used for facility-based prevocational services, sheltered workshops, or volunteer work.

2. Regulatory and Oversight Agencies

Oversight of Supported Employment in Washington is a bifurcated system shared between state agencies and local county governments. The state sets the waiver rules and processes claims, while counties manage the provider networks.

Providers interact with the county for contract compliance and the state for Medicaid billing and background checks.

• DSHS Developmental Disabilities Administration (DDA): Sets service definitions, waiver policies, and overall program rules (https://www.dshs.wa.gov/dda).
• Washington State Health Care Authority (HCA): The state Medicaid agency that manages the ProviderOne MMIS system (https://www.hca.wa.gov).
• County Developmental Disabilities Programs: Local entities (e.g., King County, Pierce County) that contract directly with providers and manage local capacity (https://kingcounty.gov/en/dept/dchs/community-services/developmental-disabilities).
• Background Check Central Unit (BCCU): DSHS division responsible for processing mandatory staff background checks (https://www.dshs.wa.gov/ffa/background-check-central-unit).

3. Gatekeeping Prerequisites: Who Can Even Apply

Washington does not allow direct-to-state Medicaid enrollment for DDA Supported Employment providers. The absolute structural precondition is securing a contract with the specific county or counties where services will be delivered.

Counties manage their own provider networks and may utilize open enrollment periods, Requests for Qualifications (RFQs), or closed networks based on local capacity needs. Without a county contract, HCA will reject the ProviderOne enrollment application.

• County Contracting: Must apply to and execute a Working Age Adult/Employment Services contract with the local County DD program.
• Network Access: Counties may restrict new provider applications if local network adequacy is met; applicants must check with the specific county coordinator for open RFQ windows.
• Business Licensure: Must hold an active Washington State Master Business License issued by the Department of Revenue.
• Entity Type: Can be a for-profit, non-profit, or governmental entity, provided it meets county qualification standards.

4. Licensure and Certification Requirements

Washington does not issue a traditional facility or agency "license" for Supported Employment providers. Instead, authority to operate is granted through DDA Policy 6.13 (Provider Qualifications) and the county contracting process.

Providers must demonstrate organizational capacity, financial stability, and adherence to DDA's Guiding Values during the county qualification review.

• DDA Qualification: Must meet the provider qualification standards outlined in DDA Policy 6.13 and WAC 388-845-2100.
• Insurance Requirements: Must maintain Commercial General Liability insurance, Professional Liability insurance, and Workers' Compensation (L&I) as dictated by the county contract.
• Accessibility: Must demonstrate that physical office locations (if clients visit) meet ADA accessibility standards.
• Accreditation: While not universally mandated by the state for this specific service, some counties may prefer or require CARF accreditation for employment providers.

5. Medicaid Provider Enrollment

Once the county contract is secured, the provider must enroll in the Washington State Health Care Authority's ProviderOne system. This is the state's Medicaid Management Information System (MMIS).

Enrollment is completed entirely online through the ProviderOne portal, requiring the upload of the executed county contract as proof of authorization.

• System: ProviderOne portal managed by HCA.
• Application Type: Non-Medical (Atypical) HCBS Provider enrollment.
• Required Documentation: Executed County DD contract, W-9, and Washington State Business License.
• NPI Requirement: While atypical providers historically did not need an NPI, HCA increasingly requires an NPI for all billing entities; providers should obtain a Type 2 NPI.
• Taxonomy Code: Typically 251S00000X (Community/Behavioral Health Agency) or as specified by HCA for DDA employment services.

6. Staffing, Training and Background Checks

Direct support professionals providing job coaching and development must meet strict background check and training requirements before working unsupervised with DDA clients.

Training focuses on supported employment best practices, person-centered planning, and client rights.

• Background Checks: All staff must clear a DSHS Background Check Central Unit (BCCU) fingerprint-based check prior to client contact.
• Age Requirement: Direct service staff must be at least 18 years of age.
• Education: High school diploma or GED equivalent is typically required.
• Initial Training: Must complete DDA-approved orientation, CPR/First Aid certification, and Bloodborne Pathogens training.
• Specialized Training: Staff must complete specific employment support training (e.g., ACRE or CESP certification) within a timeframe specified by the county contract.

7. Documentation, Policies and Records

Providers must maintain comprehensive records that align with the DDA Person-Centered Service Plan (PCSP) and county contract requirements.

Audits are conducted by both the county and DDA to ensure services billed match the documentation and progress toward employment goals.

• Service Plans: Must maintain a copy of the client's DDA PCSP and develop an individualized employment plan.
• Progress Notes: Daily or per-encounter notes detailing the specific job development or coaching activities provided, duration, and client response.
• Incident Reporting: Must comply with DDA Policy 6.12 for reporting critical incidents to the DDA case manager and county within required timeframes.
• Wage Verification: Must keep records verifying the client's employment status, hours worked, and wages earned to report to the county.
• Retention: Records must be retained for a minimum of six years following the date of service.

8. Billing, Rates and Claims

Claims for Individual Supported Employment are submitted through the ProviderOne system. Washington utilizes a tiered rate structure or standardized hourly rates depending on the specific waiver and client acuity.

Providers must only bill for direct service time or allowable job development activities as authorized in the client's PCSP.

• Billing System: Claims are submitted electronically via the ProviderOne portal.
• Procedure Codes: Typically billed using HCPCS code H2023 (Supported employment, per 15 minutes) or similar codes designated in the DDA fee schedule.
• Prior Authorization: Services must be explicitly authorized in ProviderOne by the DDA case manager before billing.
• Rate Setting: Rates are established by the state legislature and published in the DDA Supported Employment Fee Schedule.
• Claim Timeliness: Claims must generally be submitted within 365 days of the date of service.

9. Approval Sequence and Timeline

The timeline to become a billable provider depends heavily on the county's RFQ schedule. If a county only opens enrollment annually, providers must wait for that window.

Once a county application is submitted, the process through contract execution and ProviderOne enrollment typically takes 3 to 6 months.

• Step 1: Contact the local County DD program to determine network need and RFQ timelines.
• Step 2: Submit the qualification application and required policies to the county.
• Step 3: Pass county review and execute the Working Age Adult/Employment Services subcontract.
• Step 4: Submit the ProviderOne enrollment application to HCA with the county contract attached.
• Step 5: Complete BCCU background checks for initial staff and begin receiving DDA client authorizations.

10. Common Denials and Survey Findings

Applications are most frequently rejected at the county level due to a lack of demonstrated experience in customized employment or failure to follow RFQ instructions.

During audits, recoupments often occur because documentation does not support the time billed or fails to show active job development.

• County Rejection: Applying to a county that has a closed network or failing to meet the county's specific local qualification standards.
• ProviderOne Denial: Submitting the HCA application before the county contract is fully executed and signed.
• Audit Finding: Billing for unallowable activities, such as general transportation not tied to a specific job coaching goal.
• Audit Finding: Missing or expired BCCU background checks for staff providing direct services.
• Audit Finding: Progress notes that are identical day-to-day (cloned notes) failing to show individualized coaching.

11. Key Contacts and Resources

Prospective providers must utilize state and county resources to navigate the dual-layered approval process.

The primary point of contact for initial entry is always the local County Developmental Disabilities Coordinator.

• DSHS DDA Provider Information: https://www.dshs.wa.gov/dda/counties-and-providers/developmental-disabilities-administration-counties-provider-information
• HCA ProviderOne Enrollment: https://www.hca.wa.gov/billers-providers-partners/providerone
• Washington State Association of Counties (WSAC): Directory of local county DD programs (https://wsac.org).
• Washington Initiative for Supported Employment (WISE): Provides technical assistance and training for employment agencies in WA (https://www.gowise.org).
• BCCU Background Checks: https://www.dshs.wa.gov/ffa/background-check-central-unit

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