The short answer Washington licenses all in-home services under one statute — RCW 70.127 — with home care, home health, and hospice service categories on the in-home services agency license.
What Washington requires
Washington
Licensing agency. The Washington State Department of Health licenses in-home services agencies under RCW 70.127 and WAC 246-335, with distinct service categories for home care (non-medical), home health (skilled), and hospice.
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Category structure. An agency adds the categories it needs to a single in-home services license — non-medical operators take the home care category; skilled operators add home health and, if billing Medicare, federal certification.
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Workforce overlay. Washington's long-term care worker law (RCW 74.39A) requires home care aide certification (75 hours of training) and fingerprint background checks for most agency caregivers — one of the nation's most demanding caregiver credentialing regimes and a core survey focus.
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Surveys and renewal. DOH conducts an initial licensure survey, then one survey during each licensure period, plus complaint investigations with plan-of-correction requirements; an initial license runs 12 months and subsequent licenses run two years, with per-category fees on a sliding scale (RCW 70.127.090, .100).
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The federal baseline (applies in every state)
Federal
No federal home care license. There is no federal license for home care or home health agencies. Licensure is a state function: each state (and DC) decides whether and how to license home health agencies and non-medical personal care/companion agencies, so requirements vary dramatically by jurisdiction.
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Medicare certification (42 CFR Part 484). Agencies that bill Medicare for skilled home health must be certified as meeting the Medicare Conditions of Participation at 42 CFR Part 484 (patient rights, comprehensive assessment, QAPI, skilled professional services, home health aide standards, and more), on top of any state license.
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Accreditation with deemed status. Most new Medicare home health agencies obtain certification through a CMS-approved accrediting organization with deeming authority — ACHC, CHAP, or The Joint Commission — whose surveys substitute for the state agency's Medicare certification survey.
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State survey agencies enforce both. State survey agencies (usually the state health department) operate under agreements with CMS to survey Medicare-certified agencies, and most also run the state licensure survey program — initial surveys, renewal/recertification surveys, complaint investigations, and plan-of-correction enforcement per the CMS State Operations Manual.
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Primary sources for this page
- https://doh.wa.gov/licenses-permits-and-certificates/facilities-z/home-care-agencies
- https://doh.wa.gov/licenses-permits-and-certificates/facilities-z/home-care-agencies/license-requirements
- https://app.leg.wa.gov/rcw/default.aspx?cite=74.39a&full=true
- https://app.leg.wa.gov/rcw/default.aspx?cite=70.127&full=true
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