Last updated: November 2026
Washington licenses in-home services agencies by category: home care, home health and hospice; unless exempt under RCW 70.127.040 or 70.127.050, an agency needs a current Department of Health license before advertising or operating. Integral Healthcare Solutions (IHS) prepares start-up and expanding agencies for that license. We assess gaps against the rule, map the evidence, draft the policy and procedure set and run a mock survey; the owner and administrator approve and file.
What is a Washington in-home services agency license?
It is the license that Chapter 246-335 WAC, In-home services agencies (index last updated 2/3/26; page opened 2026-11-05), requires from the Washington Department of Health. The license trigger is:
WAC 246-335-315 requires a current license before advertising, operating, managing, conducting, opening or maintaining an agency unless exempt under RCW 70.127.040 or 70.127.050. Employing or contracting with two or more individuals to provide in-home services triggers licensure.
This page covers the home care sections and the fee rule. The home health and hospice parts of the chapter and the statute behind it (RCW 70.127) are outside it, so a home health or hospice owner should read those parts first.
Who needs it and what triggers it
An agency is subject to licensure if it employs or contracts with two or more individuals to provide in-home services, unless it is exempt under the statute sections the rule names. Situations that start the work:
- An owner is hiring or contracting two or more people for in-home services in Washington.
- An existing licensee wants to add a service category.
- An out-of-state operator entering Washington.
Exemption is a legal reading for the owner's counsel.
How the initial application works
Under WAC 246-335-320, an applicant (other than a hospice care center applicant) has nine months from the application submission date to complete all steps required for initial licensure or for adding a service category. The section requires:
- An applicant for initial licensure must complete a department-sponsored in-home services orientation class before submitting the application. A licensee adding a service category is not required to take the class.
- Evidence of current commercial general liability insurance.
- An initial announced survey by the department confirms the applicant meets the chapter.
- The section requires policies and procedures for each service category that clearly demonstrate compliance with the chapter. A home care agency's policies may not reference federal Medicare requirements, and may reference an accrediting organization's requirements only if the agency is accredited by it.
- Criminal history background checks processed through the Washington State Patrol and department-approved disclosure statements must be obtained within three months of application for the administrator and the supervisor of direct care services (home care) or director of clinical services (home health and hospice).
For applicants subject to the nine-month limit, failure to complete all licensing steps within that period permits close-out without a licensing-fee refund (WAC 246-335-320(4)).
After licensure, WAC 246-335-340 lets the department conduct unannounced surveys at any time and at least once during a licensure period, except for agencies approved through substantial equivalency under WAC 246-335-350. Eligibility requires department-determined equivalent standards, an on-site survey or monitoring within the previous 24 months, and the submissions in WAC 246-335-350(1)–(4). Home care agencies must also be under contract with the Department of Social and Health Services (DSHS) or an area agency on aging (AAA), submit the executed contract, and have monitoring reports submitted, including private-pay samples if applicable.
How IHS helps
- Gap assessment. We compare the owner's plan and documents with the chapter for each service category.
- Evidence map. We list each document the application and survey need and who produces it.
- Drafting. We draft the application packet, the plan of operation, the quality improvement program and the policy and procedure set. The agency's clinicians review, change and approve clinical content.
- Mock survey. We review documents and operations as a department survey would, with a findings list and drafted corrections.
The client supplies ownership and governing documents, the administrator and clinical lead, the service categories, staffing and credentials, insurance and financial records, control of the premises, and clinical sign-off on every clinical policy. IHS is led by Thomas G. Goddard, JD, PhD, founder of Integral Healthcare Solutions and former Chief Operating Officer and General Counsel of URAC. IHS covers 28 programs across three practice lines: accreditation consulting, compliance services and program development.
The real limit: the Department of Health decides whether to license an agency. IHS does not file, contact or act as liaison to the department, and it gives no legal conclusions. The owner or administrator files, attends the orientation class and handles any contact with the state.
What to have ready
Checklist sources: WAC 246-335-320, -340, -350, -415 and -455 (effective April 6, 2018), and -990 (effective June 1, 2026); pages opened November 5, 2026.
- A decision on which service categories to license (WAC 246-335-990).
- For an initial applicant, a seat in the department-sponsored orientation class, completed before the application is submitted (WAC 246-335-320).
- Current commercial general liability insurance covering bodily injury, property damage and contractual liability at a minimum of one million dollars per occurrence, or a two million dollar combined single limit (WAC 246-335-320).
- Background checks and disclosure statements for the administrator and the supervisor of direct care services or director of clinical services, obtained within three months of the application date (WAC 246-335-320).
- A home care plan of operation, starting with the organizational structure (WAC 246-335-415).
- An operating home care quality improvement program across all approved service areas: complaint receipt, investigation and disposition; problem identification, monitoring, evaluation and correction; and overall client-satisfaction assessment (WAC 246-335-455).
- A policy and procedure set for each service category (WAC 246-335-320).
- A calendar that fits the nine-month window from the submission date, unless the applicant is a hospice care center (WAC 246-335-320).
- Readiness for the announced initial survey and subsequent surveys; substantial equivalency does not prevent initial, added-category or validation surveys, surveys of uncovered categories, or complaint investigations (WAC 246-335-320, -340, -350).
When the list is mostly checked, the next step is a free introductory call.
How it compares
| Item | What it is | Where to read more |
|---|---|---|
| Washington in-home services license | State license issued by service category under chapter 246-335 WAC. | This page and the rule links above. |
| National accreditation or Medicare certification | Separate recognitions. For home health and hospice, either can bring substantial equivalency under WAC 246-335-350, which changes the survey and renewal-fee rules. | IHS's home health and hospice page covers accreditor choice. |
For home health and hospice, the reduced renewal table requires substantial equivalency and qualifying certification or accreditation; home care eligibility instead requires a qualifying DSHS or AAA contract and monitoring.
What it costs
A license has three cost parts: the Department of Health's fees, consulting fees and your own staff time.
Authority fees. WAC 246-335-990 (page opened 2026-11-05) publishes these figures:
- An initial 12-month license fee of 5,000 dollars for each service category (home care, home health, hospice). A licensee adding a category pays 5,000 dollars for each new category it does not hold.
- A county surcharge for each county of operation beyond the first: 500 dollars per additional urban county and 100 dollars per additional rural county. One county of operation is not subject to the surcharge.
- A change of ownership fee of 500 dollars for each licensed service category.
- A 24-month renewal fee based on full-time equivalents (FTEs). For an agency with 5 or fewer FTEs, the standard table lists 2,400 dollars for home care, 5,100 dollars for home health and 2,500 dollars for hospice. The department assumes at least 2 FTEs per approved service area per category.
- A discretionary 5,000 dollar fee for a necessary on-site survey to complete the survey process, address an inadequate response to deficiencies or a directed correction plan, or address a substantiated complaint investigation; it also applies to renewal licensing surveys requiring more than two on-site days.
The fee section shows an effective date of 6/1/26. Verify current fees with the Washington Department of Health.
Consulting fees. IHS scopes each engagement after a free introductory call and states no consulting fee on this page. Scope moves with the categories, the counties and whether policies already exist.
Staff time. The client assigns draft approvals, document collection and initial-license orientation attendance. WAC 246-335-320 requires an initial applicant to complete orientation before submitting the application; existing licensees adding a service category need not repeat the class.
What this is not
- It is not legal advice. IHS is a consulting firm, not a law firm. Exemptions and the reading of the rule go to the owner's counsel.
- It is not a guarantee of a license. The department decides.
- It is not a filing service. IHS does not submit to or deal with the department for the agency.
Frequently asked questions
Who needs a Washington in-home services agency license?
A person who employs or contracts with two or more individuals to provide in-home services needs a current license before advertising, operating or opening an agency, unless exempt (WAC 246-335-315). Exemptions are a legal reading for counsel.
What are the three service categories?
They are home care, home health and hospice. The license fee applies to each category, and policies and procedures must address each one the applicant will provide (WAC 246-335-320 and -990).
What does the initial application require?
WAC 246-335-320 requires the department application, signed FTE worksheet, insurance evidence, organizational description, current business license, category-specific policies, required background checks and disclosure statements, orientation certificate, fees and any other information the department requires. Initial applicants complete orientation before submission; existing licensees adding a category need not repeat the class. The initial survey is announced.
How long do I have to finish the application?
Except for hospice care center applicants, all initial or added-category licensing steps must be completed within nine months of submission under WAC 246-335-320. If those steps remain incomplete, the department may close the application without refund; the applicant may reapply at any time with an initial application and appropriate fees.
What insurance does Washington require?
WAC 246-335-320 requires evidence of current commercial general liability insurance with the initial application. The minimum is one million dollars per occurrence for bodily injury, property damage and contractual liability, or a two million dollar combined single limit.
How much does the license cost?
WAC 246-335-990 lists an initial 12-month fee of 5,000 dollars per home care, home health or hospice category, plus 500 dollars per additional urban county or 100 dollars per additional rural county beyond the first. Conditional survey fees and renewal fees are described above; verify current fees with the Washington Department of Health. IHS scopes each engagement after a free introductory call. The agency also budgets staff time.
Will the department survey a new agency without notice?
The initial survey is announced. After licensure, WAC 246-335-340 lets the department conduct unannounced surveys at any time and at least once during a licensure period, except for agencies approved through substantial equivalency under WAC 246-335-350.
What must a home care plan of operation contain?
WAC 246-335-415 requires organizational structure, job descriptions, contractor and volunteer responsibilities, services, operating hours, management and supervision across approved service areas, record preservation and filing time frames, emergency preparedness, and an administrator. The plan must address alternative services before closure or when client needs cannot be met, and remain current with practice, services and state and local law. Subsections (6), (10) and (11) detail supervision, emergency planning and administrator qualifications and duties.
How are renewal fees different for accredited or Medicare certified agencies?
Renewal is a 24-month fee based on full-time equivalents. The lower Table 2 applies only when the licensee has met the substantial equivalency requirements of WAC 246-335-350 and is Medicare certified or accredited by an organization the department recognizes (home health and hospice agencies only), or is under contract with and monitored by DSHS or the AAA (home care agencies only). Verify current fees with the department.