1. Program Definition and Services

Skilled Nursing Services in Washington provide professional clinical interventions to individuals with complex medical conditions. Delivered in the patient's home or community settings under a physician's order, these services prevent unnecessary institutionalization. Services include:

• Intermittent Skilled Nursing: Short-term, task-focused visits for stabilization or post-acute recovery (Wound care, complex dressings, IV medication administration, PICC line management, and catheter care)
• Continuous Private Duty Nursing (PDN): Extended, hourly shift care (four or more continuous hours per day) for technology-dependent individuals requiring constant clinical tracking (Mechanical ventilation monitoring, tracheostomy care, deep suctioning, and continuous infusions)

2. Regulations

The program is governed by the following regulations:

• Washington Administrative Code (WAC) Chapter 246-335
• WAC Section 182-551-2000 through 2220
• WAC Section 182-551-3000 through 3150
• WAC Section 388-106-1000 through 1055

3. Licensing or Certification

Providers must secure a Home Health Agency License from the Washington State Department of Health (DOH) under Chapter 70.127 RCW. To bill Medicaid, the agency must sign a Core Provider Agreement with the Health Care Authority (HCA) and establish a billing profile via ProviderOne.

4. Responsible State Agency

The program is co-managed by three entities: the Washington State Department of Health (DOH) handles agency licensing and nursing practice standards; the Health Care Authority (HCA) oversees broad Medicaid funding and pediatric rules; and the Department of Social and Health Services (DSHS) coordinates adult long-term care waivers through ALTSA and DDA.

5. Application Process

Applicants must first complete the mandatory DOH In-Home Services Orientation Class, then compile and submit a comprehensive Home Health Agency licensing application to the DOH. Once the DOH issues the license, the provider completes Medicaid credentialing through the HCA's ProviderOne portal to activate their billing profile.

6. Required Documentation

Providers typically need to submit:

• Secretary of State business registration (UBI number) and corporate Type 2 NPI
• DOH Home Health Agency license and orientation completion certificate
• Skilled Nursing Policy and Procedure Manual detailing CMS-compliant Plan of Care (POC) development, infection control, MAR charting, and clinical protocols
• Background check clearances for the administrator and Director of Clinical Services (DCS)
• Current professional state nursing licenses (RN/LPN) and active OIG screening records for all clinical staff
• Proof of comprehensive professional medical malpractice and general liability insurance

7. Timeline for Approval

Corporate formation and completion of the required state orientation take 3 to 5 weeks. The technical DOH licensing review combined with the ProviderOne Medicaid registration process generally requires 4 to 6 months to secure full clearance.

8. Pre-Application Process

Prospective providers must form their corporate entity with the Washington Secretary of State to secure a UBI number, establish tax accounts with the Department of Revenue, and obtain a federal EIN alongside a Home Health-specific Type 2 National Provider Identifier (NPI).

9. Pre-Application Training

The agency’s named administrator and Director of Clinical Services must attend and complete the DOH In-Home Services Orientation Class before a licensing packet will be evaluated. Practical system training for ProviderOne electronic billing is assigned after Medicaid contract execution.

10. Additional Notes

• Agencies must employ a Director of Clinical Services who is a registered nurse (RN) in Washington with a minimum of one year of supervisory or administrative experience in home health care
• The DOH will automatically close an application with no refund if the applicant fails to submit missing documentation or necessary modifications within nine months of filing
• No services can be initiated or billed without an active, signed physician’s order or an approved 60-day Plan of Care (CMS-485 format) validating medical necessity
• Continuous hourly shift care provided by LPNs or RNs under Private Duty Nursing frameworks must be verified using a state-compliant digital EVV time-capture application

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

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