How to start a behavioral health clinic in Washington

Washington requires a Behavioral Health Agency license with certifications for specific behavioral health services (e.g., outpatient mental health, outpatient SUD, opioid treatment) from Washington State Department of Health (DOH) — behavioral health agency licensing and certification to operate a behavioral health clinic. Fee: $2,250.

License required

Yes

License

Behavioral Health Agency license with certifications for specific behavioral health services (e.g., outpatient mental health, outpatient SUD, opioid treatment)

Issuing agency

Washington State Department of Health (DOH) — behavioral health agency licensing and certification

Fee

$2,250

Fee details

Application fees: new agency $2,250; branch agency $1,150; adding certifications $450; change of ownership $1,150. Annual outpatient service fee by annual service hours (non-deemed / deemed): 0-3,999 hours $1,650 / $830; 4,000-14,999 $2,400 / $1,200; 15,000-29,999 $3,200 / $1,600; 30,000-49,999 $4,750 / $2,380; 50,000+ $5,800 / $2,900. Substantiated complaint/incident investigations requiring corrective action: $2,250. (WAC 246-341-0365, effective 2025-07-15.) Half the application fee may be refunded if withdrawn before a decision.

Renewal

Every year · Annual outpatient service fee based on service hours (see fee_text); renewal requests must include full payment. Agencies file an annual form reporting accreditation status, beds and outpatient service hours.

Accreditation

Optional; nationally accredited agencies with deemed status (WAC 246-341-0310) pay roughly half the outpatient service fee. Washington is in the 2026 cohort of the federal CCBHC Medicaid demonstration.

Regulation

WAC 246-341 (incl. 246-341-0300, -0310, -0335, -0365); RCW 71.24.037

1. Prepare policies and procedures addressing every WAC 246-341 requirement for the certifications and services sought
2. Get a Washington master business license and a background check on the administrator (within three months of applying)
3. Confirm the site meets ADA, is not a personal residence, and meets local/state building and safety requirements
4. Submit the main-site licensing application signed by the designated official, listing certifications and services, with the application and service fees
5. Complete DOH review and on-site review; renew annually with the renewal fee

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.

Community/behavioral health agencies and mental health clinics — active organization NPIs (NPPES)

1,974 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

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

All Washington Behavioral health 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 →