How to start a hospice in Washington

Washington requires a In-home services agency license with hospice service category (separate hospice care center license for facilities) from Washington State Department of Health to operate a hospice. Fee: $5,000.

License required

Yes

License

In-home services agency license with hospice service category (separate hospice care center license for facilities)

Issuing agency

Washington State Department of Health

Fee

$5,000

Fee details

Initial 12-month license fee $5,000 per service category (hospice) for applicants not already licensed for in-home services; additional counties beyond the first: $500 per urban county, $100 per rural county. Change of ownership $500 per service category. Follow-up compliance surveys can cost $5,000.

Renewal

Every 2 years · 24-month renewal fee scales with paid FTEs (minimum 2 FTE assumed). Medicare-certified or recognized-accredited hospices (Table 2): $1,800 (<=5 FTE), $2,000 (6-15), $2,600 (16-50), $4,500 (51-100), $4,700 (101+). Standard (Table 1) rates are higher, e.g., $6,700 for 101+ FTE.

Accreditation

Medicare-certified or department-recognized accredited hospices that meet substantial-equivalency rules pay lower renewal fees (Table 2).

Certificate of need

Required

Medicare certification

Medicare certification is separate from the state license (state survey or CMS-approved accreditor). CMS imposed a nationwide 6-month moratorium on new Medicare hospice enrollments (including new practice locations) effective 2026-05-13, extendable in 6-month increments; applications received by the Medicare contractor before that date are still processed, accreditation cannot be used for deemed-status entry during the moratorium, and a hospice undergoing a non-exempt ownership change within 36 months of enrollment must re-enroll as new and is therefore blocked. The federal notice leaves Medicaid/CHIP hospice moratoria to each state.

Regulation

Chapter 70.127 RCW; WAC 246-335 (in-home services agencies; Part 4 hospice; fees at WAC 246-335-990); WAC 246-310-020 and 246-310-290 (Certificate of Need)

1. Obtain a Certificate of Need for a new hospice (serving a new county on an ongoing basis counts as a new hospice)
2. Apply for the in-home services agency license with the hospice service category and pay $5,000 plus county surcharges
3. Meet WAC 246-335 Part 4 hospice standards and pass the licensing survey
4. Renew every 24 months with the FTE-based 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 →

For this business

Required (licensing source)

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.

Hospice agencies (community based) — active organization NPIs (NPPES)

95 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

50 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

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

All Washington Hospice Medicaid rates, ranked →