WSR 25-24-044
PROPOSED RULES
DEPARTMENT OF HEALTH
[Filed November 26, 2025, 8:25 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 25-08-070.
Title of Rule and Other Identifying Information: In-home services agencies—Fee updates. The department of health (department) is proposing rule amendments to update and restructure fees for in-home services agencies in WAC 246-335-990.
Hearing Location(s): On January 6, 2026, at 3:00 p.m. Register in advance for this webinar at https://us02web.zoom.us/webinar/register/WN_U7QaOtTfSR2twnV5caIm5Q. After registering, you will receive a confirmation email containing information about joining the webinar. The department will be offering a virtual webinar hearing only. Individuals may attend virtually or submit comments in writing.
Date of Intended Adoption: January 9, 2026.
Submit Written Comments to: John Hilger, P.O. Box 47850, Olympia, WA 98504-7850, email HSQAFeeRules@doh.wa.gov, https://fortress.wa.gov/doh/policyreview/, beginning the date and time of filing, by January 6, 2026, at 11:59 p.m.
Assistance for Persons with Disabilities: Contact John Hilger, phone 360-236-2929, TTY 711, email john.hilger@doh.wa.gov, web doh.wa.gov, by December 30, 2025.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The department is proposing amendments to WAC 246-335-990 to increase and restructure in-home services fees for initial license, renewal, and other charges. Rule making is necessary to comply with RCW
43.70.250, update current rule language, and create an enforceable fee schedule. The department is proposing the following changes:
| |
| • | Requiring a minimum two full-time employees per county per service for renewal fees. |
| • | Eliminating the multiservice discount. |
| • | Introducing a county-based surcharge. |
| • | Implementing a discount for accredited and department of social and health services contracted agencies. |
| • | Increasing fee amounts for initial application, renew, change of ownership, and other administrative fees. |
Reasons Supporting Proposal: RCW
43.70.250 requires that licensure fees fully fund the work of licensing and regulating health care facilities. Current in-home services revenue, including fees for home care, home health, and hospice agencies, is insufficient to cover operating costs for the in-home services regulatory program (program). Current revenue is insufficient to recover operating expenditures for the program. The program ended fiscal year 2024 with a revenue shortfall of $245,000. The department anticipates the current funding gap to widen as costs continue to increase in upcoming years, leading to a projected biennial shortfall of $1,229,000 in the 2032-2033 biennium. To ensure the program's financial sustainability and maintain compliance with state statutory requirements, a fee increase is necessary.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of health, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: John Hilger, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-2929.
A school district fiscal impact statement is not required under RCW
28A.305.135.
A cost-benefit analysis is not required under RCW
34.05.328. This rule is exempt from analysis according to RCW
34.05.328 (5)(b)(vi) because it is a rule that sets or adjusts fees pursuant to legislative standards.
This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:
Is exempt under RCW
19.85.025(3) as the rules set or adjust fees under the authority of RCW
19.02.075 or that set or adjust fees or rates pursuant to legislative standards, including fees set or adjusted under the authority of RCW
19.80.045.
Explanation of exemptions: The proposed rules set and adjust fees for in-home services agencies, including home care, home health, and hospice agencies, under RCW
34.05.310 (4)(f).
Scope of exemption for rule proposal:
Is fully exempt.
November 26, 2025
Kristin Peterson, JD
Chief of Policy
for Dennis E. Worsham
Secretary of Health
RDS-6826.4
AMENDATORY SECTION(Amending WSR 18-06-093, filed 3/6/18, effective 4/6/18)
WAC 246-335-990Fees.
(1) Initial license. An applicant shall submit to the department an initial ((twelve))12-month license fee of ((three thousand two hundred eighty-three dollars))$5,000 for each service category (home care, home health, hospice) for persons not currently licensed to provide in-home services in Washington state.
(2) Adding new service categories to existing license. A licensee shall submit to the department an initial ((twelve))12-month license fee of ((three thousand two hundred eighty-three dollars))$5,000 for each new service category (home care, home health, hospice, hospice care center) for licensees not currently licensed in that category to provide in-home services in Washington state.
(3) County surcharge. An applicant or licensee shall submit to the department a service area county surcharge. One county of operation for each applicant or licensee is not subject to a county surcharge. Each additional county of operation is charged at:
(a) $500 per urban county; and
(b) $100 per rural county.
(4) Renewal license. A licensee shall submit to the department a ((twenty-four))24 month renewal fee for home care, home health and hospice agencies, based on the number of full-time equivalents (FTEs), which is a measurement based on a ((forty))40 hour week and is applicable to paid agency personnel or contractors, according to Tables 1 and 2 of this section. The department will assume a minimum of ((1))2 FTE for each approved service area per service category. The licensee shall submit to the department a ((twenty-four))24 month renewal fee for hospice care centers, based on the number of beds, according to Tables 1 and 2 of this section((:)).
(a) ((For licenses with a single service category))Unless eligible under (b) of this subsection, a licensee shall submit to the department applicable fees under Table 1:
Table 1 - Standard Renewal Fees
# of FTEs | Home Care | Home Health | Hospice | # of Beds | Hospice Care Center |
5 or less | | (($1,530.00))$2,400.00 | | (($3,283.00))$5,100.00 | | (($1,642.00))$2,500.00 | | 5 or less | (($1,642.00))$2,500.00 | |
6 to 15 | | (($1,783.00))$2,800.00 | | (($4,618.00))$7,200.00 | | (($1,856.00))$2,900.00 | | 6 to 10 | (($2,190.00))$3,400.00 | |
16 to 50 | | (($1,916.00))$3,000.00 | | (($5,256.00))$8,100.00 | | (($2,383.00))$3,700.00 | | 11 to 15 | (($3,283.00))$5,100.00 | |
51 to 100 | | (($2,244.00))$3,500.00 | | (($6,623.00))$10,300.00 | | (($4,120.00))$6,400.00 | | 16 to 20 | (($4,378.00))$6,800.00 | |
101 or more | | (($2,408.00))$3,700.00 | | (($6,820.00))$10,600.00 | | (($4,335.00))$6,700.00 | | | |
(b) ((For licenses with multiple service categories:
(i) One hundred percent of the home health category fee and seventy-five percent of the appropriate service category fee for each additional service category (home care, hospice, hospice care center); or
(ii) One hundred percent of the hospice category fee and seventy-five percent of the appropriate service category fee for each additional service category (home care, hospice care center).
(4)))A licensee shall submit to the department applicable fees under Table 2 when a licensee has satisfied the substantial equivalency requirements of WAC 246-335-350 and:
(i) Is medicare certified (home health and hospice agencies only);
(ii) Is accredited by an accrediting organization recognized by the department (home health and hospice agencies only); or
(iii) Is under contract with and monitored by DSHS or the AAA (home care agencies only).
Table 2 - Renewal Fees for Facilities Certified by Medicare, Accredited, or Contracted by DSHS or AAA
# of FTEs | Home Care | Home Health | Hospice | # of Beds | Hospice Care Center |
5 or less | | $1,700.00 | | $3,600.00 | | $1,800.00 | | 5 or less | $1,800.00 | |
6 to 15 | | $2,000.00 | | $5,000.00 | | $2,000.00 | | 6 to 10 | $2,400.00 | |
16 to 50 | | $2,100.00 | | $5,700.00 | | $2,600.00 | | 11 to 15 | $3,600.00 | |
51 to 100 | | $2,500.00 | | $7,200.00 | | $4,500.00 | | 16 to 20 | $4,800.00 | |
101 or more | | $2,600.00 | | $7,400.00 | | $4,700.00 | | | |
(5) Change of ownership. A change of ownership fee of ((three hundred fifty dollars))$500 for each licensed service category (home care, home health, hospice, hospice care center). A new license will be issued and valid for the remainder of the current license period.
(((5)))(6) The department may charge and collect from a licensee a fee of ((one thousand five hundred thirty dollars))$5,000 for:
(a) An on-site follow-up compliance survey deemed necessary in order to complete the survey process;
(b) An on-site compliance survey deemed necessary due to failure of the licensee to adequately respond to a statement of deficiencies or a directed plan of correction;
(c) An on-site compliance survey deemed necessary due to a substantiated complaint investigation; or
(d) State licensing surveys conducted during renewal periods that require on-site survey time beyond two days.
(((6)))(7) A licensee that is not subject to the state survey requirement according to WAC 246-335-350 shall pay fees according to this section.
(((7)))(8) A licensee shall submit an additional late fee in the amount of ((fifty dollars))$50 per day. The additional late fee will not exceed ((six hundred fifty dollars))$1,000, from the renewal date, which is ((thirty))30 days before the current license expiration date, until the date of mailing the fee, as evidenced by the postmark, or electronic submission.
(((8)))(9) Refunds. The department shall refund fees paid by the applicant for initial licensure as follows:
(a) If an application has been received but no on-site survey or technical assistance has been performed or provided by the department, two-thirds of the fees paid, less a ((fifty dollar))$50 processing fee; or
(b) If an application has been received and an on-site survey or technical assistance has been performed or provided by the department, one-third of the fees paid, less a ((fifty dollar))$50 processing fee.
(((9)))(10) The department may not refund applicant fees if:
(a) The department has performed more than one on-site visit for any purpose;
(b) Nine months has elapsed since an initial licensure application is received by the department, but no license has been issued due to applicant's failure to complete the requirements for licensure; or
(c) The amount to be refunded as calculated by subsection (((8)))(9)(a) or (b) of this section is ten dollars or less.