How to start an ABA practice in Washington

Washington requires a Licensed Behavior Analyst (LBA); Licensed Assistant Behavior Analyst (LABA); Certified Behavior Technician (CBT) from Washington State Department of Health (DOH) to operate an ABA practice. Fee: $250.

License required

Yes

License

Licensed Behavior Analyst (LBA); Licensed Assistant Behavior Analyst (LABA); Certified Behavior Technician (CBT)

Issuing agency

Washington State Department of Health (DOH)

Fee

$250

Fee details

Application and initial credential: LBA $250; LABA $160; CBT $95. LBA temporary license $50 (WAC 246-805-990).

Renewal

Every 2 years · Renew every two years on the practitioner's birthday. Renewal: LBA $350, LABA $175, CBT $150. Late renewal penalty: LBA $175, LABA $90, CBT $75.

Professional license

board: Washington State Department of Health (applied behavior analysis program); statute: RCW 18.380; WAC 246-805 (fees at 246-805-990); behavior analyst: LBA license required.; assistant behavior analyst: LABA license, practicing with supervision from an LBA or licensed psychologist.; technician: Yes. Washington has a state technician requirement: frontline staff hold a DOH Certified Behavior Technician (CBT) credential ($95 initial, $150 biennial renewal). Apple Health also requires CBTs to enroll individually as servicing providers.; medicaid enrollment: Apple Health ABA (WAC 182-531A) requires a COE provider's comprehensive diagnostic evaluation and prescription. The LBAT (LBA or LABA, or certain other licensed clinicians with HCA attestation form 13-0008) and each CBT enroll as servicing providers under WAC 182-502. MCO-contracted services also require MCO contracting.

Regulation

RCW 18.380; WAC 246-805-990; WAC 182-531A-0800

1. Apply to DOH for the LBA, LABA or CBT credential and pay the fee
2. CBTs and LABAs practice under qualifying supervision (WAC 246-805)
3. Renew every two years on your birthday
4. Apple Health: get a COE (center of excellence) diagnostic evaluation and prescription for the client; the LBAT and CBT each enroll as HCA servicing providers

Staffing

• Apple Health: the lead behavior analysis therapist (LBA, or LABA with LBA/psychologist supervision) must supervise at least 5% of total weekly direct care provided by each CBT
• CBTs must be supervised by a DOH-licensed professional meeting WAC 246-805-330 and review client progress with the supervisor at least every two weeks

Program

Washington Apple Health (Medicaid), Washington State Health Care Authority (HCA)

Enrollment portal

ProviderOne

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. HCA's enrollment and revalidation pages do not list a separate state fee.

Fingerprinting

Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. HCA's enrollment and revalidation pages do not describe a separate state fingerprint process.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. HCA's enrollment and revalidation pages do not describe a separate state site visit process.

Revalidation

HCA revalidates providers every five years under 42 CFR 455 and mails one letter per group or facility to the ProviderOne mailing address. The provider has 30 days from the notice date. After that a deactivation notice is sent and the provider gets 90 more days before billing privileges are affected. Billing providers revalidate through ProviderOne's 'Manage Provider Information' Business Process Wizard. They update ownership, managing-employee and controlling-interest disclosures and submit the Core Provider Agreement, Debarment Statement, W-9 and type-specific documents. Nonbilling providers use the nonbilling forms and the HCA support portal or fax. HCA and DSHS are doing off-cycle revalidations of certain providers by June 5, 2028.

Full Washington Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Washington State Department of Health, Certificate of Need Program

Services covered

• new health care facilities: hospitals, behavioral health hospitals, nursing homes, hospices and hospice care centers, home health agencies, kidney disease treatment centers, ambulatory surgical facilities
• sale, purchase or lease of an existing hospital
• nursing home capital expenditures above the expenditure minimum or that substantially change services
• bed capacity increases and redistribution among acute, nursing home and assisted living care
• new tertiary health services
• added dialysis stations

Washington certificate of need details →

State minimum wage

$17.13 an hour

Effective

2026-01-01

Scheduled increases

Rises to $17.73 on 2027-01-01 (CPI-W indexing; no tip credit).

Rate pass-through

When individual-provider home care wages and benefits change under the collective bargaining agreement, DSHS adds the per-quarter-hour amount to the home care agency vendor rate, and agencies must use any increase only for direct-care workers' wages, benefits and related employer costs. From FY2028 a set share of the vendor rate is dedicated to compensation, with verification of agency spending from 2027-07-01.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Applied behavior analysis organizations — active organization NPIs (NPPES)

270 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,781,187 (as of Jun 1, 2026)

All Washington ABA Medicaid rates, ranked →

• WA Basic Plus Waiver (1915(c))
• WA Children's Intensive In-Home Behavioral Support Waiver (1915(c))
• WA Community Protection Waiver (1915(c))
• WA COPES Waiver (1915(c))
• WA Core Waiver (1915(c))
• WA Individual and Family Services Waiver (1915(c))
• WA New Freedom Waiver (1915(c))
• WA Residential Support Waiver (1915(c))
• Washington Medicaid Transformation Project 2.0 (1115)

Washington waivers and waiting lists →