RESPITE CARE SERVICES PROVIDER IN WASHINGTON
GIVING FAMILY CAREGIVERS A BREAK WHILE ENSURING SAFE, COMPASSIONATE SUPPORT FOR LOVED ONES AT HOME OR IN THE COMMUNITY

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Respite Care Services in Washington provide temporary relief for primary caregivers of individuals with disabilities, chronic illnesses, or age-related limitations. Whether a few hours or several days, respite care ensures that the individual receives safe and supportive services, while the caregiver rests, attends to other duties, or prevents burnout.

Respite is covered under multiple Washington Medicaid waiver programs, including the Community First Choice (CFC) program, Core Waiver, Basic Plus Waiver, and Individual and Family Services (IFS). It may be delivered in-home, in a licensed facility, or through community-based respite programs.

Oversight is managed by the Developmental Disabilities Administration (DDA) and the Department of Social and Health Services (DSHS), with Medicaid funding administered through the Health Care Authority (HCA).

1. GOVERNING AGENCIES

Agency: Developmental Disabilities Administration (DDA)
Role: Authorizes and monitors respite services for individuals with developmental disabilities.

Agency: Department of Social and Health Services (DSHS)
Role: Supports caregiver programs, licensing, and direct provider contracts.

Agency: Health Care Authority (HCA)
Role: Oversees Medicaid reimbursement and policy compliance under Apple Health.

2. RESPITE SERVICES OVERVIEW

Respite care gives unpaid caregivers a short-term break by having trained professionals provide temporary support to the care recipient.

Covered respite options include:

In-Home Respite Care – Provided by a Direct Support Professional (DSP) in the individual's home

Out-of-Home Respite – In a licensed adult family home, assisted living facility, or certified respite home

Community-Based Respite Programs – Structured daytime supervision in group or activity settings

Planned or Emergency Respite – Scheduled relief or crisis-driven coverage

Respite care must be listed in the individual’s Person-Centered Service Plan (PCSP) and pre-authorized by DDA or another funding body.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Washington Secretary of State

Obtain an EIN and Type 2 NPI

Qualify as a DDA Respite Provider

For out-of-home respite: Obtain a DSHS residential care license

Complete ProviderOne Medicaid enrollment

Develop a Respite Services Policy & Procedure Manual

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI
Step 2: Apply to DDA to become a respite provider (individual or agency)
Step 3: Complete background checks and staff credentialing
Step 4: Enroll in ProviderOne for Medicaid billing
Step 5: Coordinate with DDA or case manager for referrals
Step 6: Begin delivering services once authorized in the PCSP

5. REQUIRED DOCUMENTATION

State registration, EIN, and NPI

DDA or DSHS provider qualification letter

ProviderOne enrollment confirmation

Respite Policy & Procedure Manual including:

Caregiver communication and service planning

Staff supervision and incident response protocols

Emergency, medication, and safety procedures

Documentation tools (e.g., daily logs, time sheets, shift notes)

HIPAA, participant rights, and grievance processes

Background check clearance and staff training logs

6. STAFFING REQUIREMENTS

Role: Respite Worker / Direct Support Professional (DSP)
Requirements:

Must pass DSHS background checks

CPR/First Aid certification

DDA-approved training (e.g., 75-hour core, orientation, or skills development depending on setting)

Role: Supervisor / Program Coordinator (Recommended for agencies)
Responsibilities:

Oversight of services, safety, documentation, and staff support

All staff must complete:

HIPAA and client rights training

Abuse prevention and emergency protocols

Service-specific care skills training

Ongoing competency evaluations

7. MEDICAID WAIVER PROGRAMS THAT COVER RESPITE

Respite is an approved service under:

Community First Choice (CFC) – For clients eligible for State Plan personal care

Basic Plus Waiver – Flexible respite for individuals living at home

Core Waiver – For those requiring higher levels of ongoing support

Individual and Family Services (IFS) Waiver – Respite provided based on a participant’s annual service budget

Tailored Supports for Older Adults (TSOA) – Short-term caregiver support for non-Medicaid populations

Each waiver defines specific service limits, provider types, and reimbursement rates.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Staff Onboarding
Timeline: 2–3 weeks

Phase: DDA Approval & Medicaid Enrollment
Timeline: 4–8 weeks

Phase: Policy Manual Development & Training
Timeline: 2–4 weeks

Phase: Service Launch
Timeline: Begins upon PCSP authorization and client intake

9. CONTACT INFORMATION

Developmental Disabilities Administration (DDA)
Website: https://www.dshs.wa.gov/dda

DSHS Respite Programs & Licensing
Website: https://www.dshs.wa.gov/altsa

Washington State Health Care Authority (HCA)
Website: https://www.hca.wa.gov

ProviderOne Medicaid Enrollment Portal
Website: https://www.waproviderone.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON RESPITE CARE PROVIDER
WCG supports caregivers and agencies in building high-quality respite care programs that meet family needs and state compliance standards.

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Scope of Work:

DDA provider enrollment and Medicaid registration

Respite Policy & Procedure Manual and forms toolkit

Staff orientation templates and background check tracking

Documentation logs, shift notes, and emergency plans

Client intake, PCSP alignment, and incident report systems

RESIDENTIAL SUPPORT SERVICES PROVIDER IN WASHINGTON
OFFERING 24/7 SUPPORT IN COMMUNITY-BASED SETTINGS TO PROMOTE SAFETY, SKILL DEVELOPMENT, AND INDEPENDENT LIVING

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Residential Support Services in Washington provide community-based living arrangements with round-the-clock supervision, personal care, and life skills assistance to individuals with developmental, intellectual, or physical disabilities. These supports empower individuals to live safely outside institutional settings and thrive in a home-like environment that aligns with their person-centered service plan (PCSP).

Residential services are primarily authorized under Home and Community-Based Services (HCBS) waivers administered by the Developmental Disabilities Administration (DDA)—specifically the Core Waiver and Community Protection Program. Oversight and funding are coordinated by the Department of Social and Health Services (DSHS) and the Health Care Authority (HCA) through Medicaid.

1. GOVERNING AGENCIES

Agency: Developmental Disabilities Administration (DDA)
Role: Manages residential programs for eligible individuals, authorizes provider participation, and ensures quality of care.

Agency: Department of Social and Health Services (DSHS)
Role: Conducts background checks, licensing, and program monitoring for supported living and group home settings.

Agency: Health Care Authority (HCA)
Role: Oversees Medicaid reimbursement through Apple Health and ProviderOne.

2. RESIDENTIAL SUPPORT SERVICES OVERVIEW

Residential Support may be delivered in various licensed or certified settings, including:

Supported Living – Individuals live in their own home or apartment with agency-provided supports

Group Homes – Shared housing with 24/7 staffing

Companion Homes – Individuals live with contracted caregivers

State-licensed facilities (e.g., Adult Family Homes, Assisted Living)

Core services include:

Assistance with ADLs and IADLs (bathing, cooking, managing medications)

Supervision and protective oversight

Skill building for self-care, budgeting, communication, and community engagement

Crisis intervention and behavioral support (if needed)

Support with medical, therapy, and employment coordination

All services must align with the participant’s Individualized Residential Support Plan (IRSP).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Washington Secretary of State

Obtain an EIN and Type 2 NPI

Apply for provider status with DDA as a Residential Services Provider

Meet certification requirements for Supported Living Agencies (per WAC 388-101)

Enroll in Medicaid through ProviderOne

Maintain liability insurance, complete background checks, and implement required staff training

Develop a Residential Services Policy & Procedure Manual

Housing Requirements:

Must meet state life safety codes, occupancy, and accessibility standards

May need to pass DSHS Residential Inspection or Certification Review

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business, secure EIN and NPI
Step 2: Apply with DDA as a qualified residential provider
Step 3: Complete Medicaid enrollment in ProviderOne
Step 4: Pass facility inspections and staff background checks
Step 5: Submit required P&P Manual, organizational structure, and client onboarding process
Step 6: Begin receiving referrals and develop IRSPs with case managers

5. REQUIRED DOCUMENTATION

DDA Residential Services provider approval

Medicaid enrollment via ProviderOne

Proof of insurance and staff credentialing

Residential Services Policy & Procedure Manual, including:

Resident admission and service planning process

Daily living support and staffing ratio policies

Emergency preparedness and safety drills

Incident reporting and abuse prevention

Behavior support and communication plan templates

Medication administration and shift documentation

Client rights, grievance policy, and HIPAA protocols

6. STAFFING REQUIREMENTS

Role: Direct Support Professional (DSP)
Requirements:

Complete 75-hour caregiver training or DDA-approved curriculum

Pass DSHS background check

Provide ADL assistance, supervision, and goal tracking

Role: Residential Program Manager
Responsibilities: Supervises staff, coordinates with case managers, ensures compliance with PCSPs and IRSPs

Role: Behavioral Support Specialist (if applicable)
Responsibilities: Implements Behavior Support Plans (BSPs)

All staff must complete:

CPR/First Aid and Abuse Prevention training

HIPAA and client confidentiality compliance

Medication administration and documentation procedures

Fire and emergency response drills

Ongoing training and annual competency reviews

7. MEDICAID PROGRAMS THAT COVER RESIDENTIAL SUPPORT

Residential Services are available under:

Core Waiver (DDA) – Primary program for residential habilitation

Community Protection Program (CPP) – Intensive services for individuals with high support needs or history of risky behavior

Basic Plus Waiver (limited) – May fund community support but not 24-hour residential services

Apple Health – Covers nursing and some behavioral services in residential settings

All residential services require prior authorization and alignment with the IRSP.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Licensing Prep
Timeline: 2–4 weeks

Phase: DDA Certification and ProviderOne Enrollment
Timeline: 2–3 months

Phase: Facility Readiness and Staff Credentialing
Timeline: 1–2 months

Phase: Launch of Services
Timeline: Begins once housing is approved and referrals are matched

9. CONTACT INFORMATION

Developmental Disabilities Administration (DDA)
Website: https://www.dshs.wa.gov/dda

DSHS Residential Services and Supported Living Info
Website: https://www.dshs.wa.gov/dda/residential-services

Health Care Authority (HCA)
Website: https://www.hca.wa.gov

ProviderOne Portal
Website: https://www.waproviderone.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON RESIDENTIAL SUPPORT PROVIDER
WCG helps organizations launch certified residential programs that meet DDA, Medicaid, and safety standards.

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Scope of Work:

ProviderOne and DDA enrollment guidance

Residential Policy & Procedure Manual development

Facility readiness checklists and inspection prep

IRSP templates and staffing documentation

Client intake packets and medication administration logs

Staff orientation materials and ongoing compliance tools

SUPPORTED EMPLOYMENT SERVICES PROVIDER IN WASHINGTON
EMPOWERING INDIVIDUALS WITH DISABILITIES TO OBTAIN AND MAINTAIN MEANINGFUL, INCLUSIVE EMPLOYMENT IN THEIR COMMUNITIES

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Supported Employment Services in Washington help individuals with intellectual, developmental, or significant disabilities prepare for, secure, and retain competitive jobs in integrated community settings. These services focus on individualized job development, on-the-job support, and long-term employment sustainability, promoting independence and economic self-sufficiency.

Supported Employment is funded through the Developmental Disabilities Administration (DDA) under Washington Medicaid waiver programs such as Basic Plus, Individual and Family Services (IFS), and Core Waiver, as well as through county employment programs and partnerships with the Division of Vocational Rehabilitation (DVR).

1. GOVERNING AGENCIES

Agency: Developmental Disabilities Administration (DDA)
Role: Administers waiver-based Supported Employment for individuals with ID/DD; sets service definitions and provider qualifications.

Agency: Washington State Health Care Authority (HCA)
Role: Oversees Medicaid funding for DDA waiver services and ensures compliance.

Agency: Division of Vocational Rehabilitation (DVR)
Role: Provides short-term vocational services and funding for job readiness and placement.

Agency: County Developmental Disabilities Programs
Role: Contracts with providers and administers local Supported Employment programs in coordination with DDA.

2. SUPPORTED EMPLOYMENT SERVICES OVERVIEW

Supported Employment assists individuals in securing and maintaining integrated jobs at or above minimum wage.

Key components include:

Discovery & Person-Centered Planning

Job Development and Placement

Job Coaching and Training

Follow-Along Support

Employer Engagement and Education

Transportation coordination and travel training

All services must be tied to the individual’s Person-Centered Service Plan (PCSP) and documented in line with DDA requirements.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Washington Secretary of State

Obtain an EIN and Type 2 NPI

Contract with DDA as a Qualified Employment Provider

Meet DDA’s staff qualification and training standards

Obtain approval from the county developmental disabilities program

Complete Medicaid enrollment via ProviderOne

Create a Supported Employment Services Policy & Procedure Manual

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN and NPI
Step 2: Apply to DDA to become a Qualified Employment Provider
Step 3: Meet county contracting and credentialing requirements
Step 4: Enroll in Medicaid via the ProviderOne portal
Step 5: Hire and train Employment Specialists
Step 6: Begin services upon PCSP authorization and DVR coordination

5. REQUIRED DOCUMENTATION

Secretary of State registration, EIN, and NPI

DDA approval letter as a Qualified Employment Provider

Medicaid enrollment confirmation

County contract (varies by jurisdiction)

Supported Employment Policy & Procedure Manual including:

Discovery and job development tracking

Individual employment support logs

Staff supervision and training protocols

Documentation of community integration and employer outreach

Participant progress reports and follow-up plans

Transportation support documentation

HIPAA, incident reporting, and rights policies

6. STAFFING REQUIREMENTS

Role: Employment Specialist / Job Coach
Requirements:

High school diploma or equivalent (Bachelor’s preferred)

Completion of DDA-approved employment training

Background check and OIG screening

Proficiency in person-centered and vocational planning

Role: Employment Program Supervisor (Recommended)
Responsibilities:

Oversight of service delivery, staff performance, and employer relationships

All staff must complete:

Mandatory training in person-centered employment planning

Community inclusion and disability awareness

Job development and coaching strategies

Documentation, confidentiality, and safety training

7. MEDICAID WAIVER PROGRAMS & FUNDING SOURCES

Supported Employment is funded through:

Basic Plus Waiver – Ongoing job support and coaching

Core Waiver – More intensive employment support for high-need individuals

Individual and Family Services (IFS) Waiver – Flexible employment supports for those living with family

County Programs – Local funding and coordination of Supported Employment services

Division of Vocational Rehabilitation (DVR) – Time-limited pre-employment or placement funding

Each service must be listed in the individual’s PCSP and approved by the DDA case manager.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Staffing
Timeline: 3–4 weeks

Phase: DDA Qualification & County Contracting
Timeline: 2–3 months

Phase: Medicaid Enrollment & ProviderOne Setup
Timeline: 4–6 weeks

Phase: Launch of Services
Timeline: Begins after participant referral and PCSP authorization

9. CONTACT INFORMATION

Developmental Disabilities Administration (DDA)
Website: https://www.dshs.wa.gov/dda

Washington State Health Care Authority (HCA)
Website: https://www.hca.wa.gov

ProviderOne Medicaid Enrollment Portal
Website: https://www.waproviderone.org

Division of Vocational Rehabilitation (DVR)
Website: https://www.dshs.wa.gov/dvr

County Developmental Disabilities Contacts
Directory: https://www.dshs.wa.gov/dda/county-best-practices

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON SUPPORTED EMPLOYMENT PROVIDER
WCG helps mission-driven organizations and employment programs establish robust supported employment services with DDA, county, and Medicaid compliance.

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Scope of Work:

DDA and Medicaid provider enrollment

County contract navigation and documentation

Supported Employment Policy & Procedure Manual

Staff training plan, supervision forms, and credentialing logs

Employer outreach tools, job tracking templates, and service logs

HIPAA, participant rights, and safety procedure setup

PERSONAL CARE SERVICES PROVIDER IN WASHINGTON
SUPPORTING INDIVIDUALS WITH DAILY LIVING TASKS TO PROMOTE DIGNITY, SAFETY, AND INDEPENDENCE AT HOME

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Personal Care Services in Washington provide non-medical assistance with daily activities for individuals who need help due to age, illness, disability, or chronic conditions. These services allow people to remain in their homes and communities while receiving the essential support they need.

Personal Care is covered under Washington’s Apple Health (Medicaid) State Plan and through various Home and Community-Based Services (HCBS) waivers, such as the Community First Choice (CFC) Option, COPES, and New Freedom Waiver. Oversight is provided by the Washington State Health Care Authority (HCA) and the Department of Social and Health Services (DSHS) via the Aging and Long-Term Support Administration (ALTSA).

1. GOVERNING AGENCIES

Agency: Washington State Health Care Authority (HCA)
Role: Administers Apple Health (Medicaid) and ensures medical necessity and reimbursement processes for personal care services.

Agency: Department of Social and Health Services (DSHS) – ALTSA Division
Role: Oversees long-term care and waiver-based personal care services; manages contracts and provider qualifications.

Agency: Developmental Disabilities Administration (DDA)
Role: Coordinates personal care for individuals with developmental or intellectual disabilities under specific HCBS waivers.

2. PERSONAL CARE SERVICES OVERVIEW

Personal Care Services support individuals in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), based on an authorized Person-Centered Service Plan (PCSP).

Covered services include:

Bathing, dressing, grooming, and hygiene

Mobility and transfers

Toileting and incontinence care

Meal preparation and eating assistance

Light housekeeping and laundry

Medication reminders (non-nursing)

Community access and safety monitoring

Services can be agency-based or consumer-directed (Individual Provider Program), depending on the participant's preference and waiver eligibility.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Washington Secretary of State

Obtain an EIN and Type 2 NPI

Apply for a Home Care Agency License through the Washington State Department of Health (DOH)

Complete the DSHS contract process to serve Medicaid clients

Enroll as a provider with HCA’s ProviderOne system

Develop a Personal Care Policy & Procedure Manual per state standards

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN and NPI
Step 2: Apply for Home Care Agency License via DOH
Step 3: Complete DSHS Medicaid provider contracting
Step 4: Enroll in ProviderOne for Medicaid billing
Step 5: Hire and train certified home care aides (HCAs)
Step 6: Begin service delivery once participant’s PCSP is authorized

5. REQUIRED DOCUMENTATION

Secretary of State registration, EIN, and NPI

DOH Home Care Agency license

Medicaid provider approval from DSHS

Personal Care Policy & Procedure Manual including:

ADL/IADL task protocols

Service documentation and time tracking

Medication assistance guidelines

Client rights and grievance procedures

Staff orientation, training logs, and supervision plans

Incident reporting and infection control

HIPAA and abuse prevention measures

6. STAFFING REQUIREMENTS

Role: Home Care Aide (HCA)
Requirements:

Certified by DOH as a Home Care Aide

Must complete 75-hour training and pass the state exam

CPR/First Aid certification

Background checks via DSHS

Role: Nurse Delegator (if applicable)
Responsibilities:

Delegates and supervises certain nursing tasks to HCAs (e.g., insulin injections, catheter care)

All staff must complete:

Mandatory reporter and abuse prevention training

HIPAA and confidentiality modules

Infection control and emergency preparedness

Annual continuing education (CE)

7. MEDICAID WAIVER PROGRAMS & OPTIONS

Personal Care Services are provided under:

Community First Choice (CFC) – State Plan benefit for individuals eligible for Apple Health and needing ADL/IADL support

COPES Waiver – For individuals requiring a nursing facility level of care but preferring to stay at home

New Freedom Waiver – Offers self-directed personal care services with individualized budgets

Basic Plus and Core Waivers (via DDA) – For clients with developmental disabilities

All services require authorization via a Person-Centered Service Plan developed by a DSHS case manager or DDA representative.

8. TIMELINE TO LAUNCH

Phase: Business Registration & HCA Licensing Prep
Timeline: 3–5 weeks

Phase: DOH Licensing & DSHS Contracting
Timeline: 2–3 months

Phase: ProviderOne Enrollment & Staff Hiring
Timeline: 4–6 weeks

Phase: Service Launch
Timeline: Begins after staff are certified and participant plans are authorized

9. CONTACT INFORMATION

Washington State Department of Health (DOH) – Home Care Agency Licensing
Website: https://www.doh.wa.gov

Washington State Health Care Authority (HCA)
Website: https://www.hca.wa.gov

ProviderOne Enrollment Portal
Website: https://www.waproviderone.org

Department of Social and Health Services (DSHS) – ALTSA
Website: https://www.dshs.wa.gov/altsa

Developmental Disabilities Administration (DDA)
Website: https://www.dshs.wa.gov/dda

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON PERSONAL CARE PROVIDER
WCG assists agencies in navigating Washington’s multi-agency system, from licensing and Medicaid approval to staffing and documentation for compliant, high-quality personal care delivery.

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Scope of Work:

DOH licensing and Medicaid contracting support

ProviderOne billing setup and user guidance

Personal Care Services Policy & Procedure Manual

Staff onboarding and HCA credentialing checklist

Visit logs, time tracking, and PCSP alignment tools

Client safety, incident reporting, and HIPAA compliance protocols

ADAPTIVE EQUIPMENT SERVICES PROVIDER IN WASHINGTON
ENABLING INDEPENDENCE AND SAFETY THROUGH CUSTOMIZED TOOLS, DEVICES, AND EQUIPMENT THAT SUPPORT DAILY LIVING

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Adaptive Equipment Services in Washington focus on providing specialized medical devices, assistive tools, and equipment that improve the functional capabilities of individuals with disabilities or chronic health conditions. These tools empower individuals to perform daily activities more independently, safely, and comfortably in their homes and communities.

These services are typically authorized through Medicaid Home and Community-Based Services (HCBS) Waivers, including Basic Plus, Core, and Individual and Family Services (IFS) waivers administered by the Developmental Disabilities Administration (DDA). Funding and oversight are also supported by the Washington Health Care Authority (HCA) under Apple Health Medicaid.

1. GOVERNING AGENCIES

Agency: Developmental Disabilities Administration (DDA)
Role: Assesses needs, authorizes adaptive equipment, and monitors service delivery as part of the participant’s Person-Centered Service Plan (PCSP).

Agency: Health Care Authority (HCA)
Role: Oversees Medicaid funding, compliance, and reimbursement processes.

Agency: Department of Social and Health Services (DSHS)
Role: Coordinates with DDA and ALTSA (for non-DD clients) to facilitate service access.

2. ADAPTIVE EQUIPMENT SERVICES OVERVIEW

Adaptive equipment includes devices and modifications that assist with:

Activities of daily living (ADLs)

Mobility and transfers

Communication and sensory access

Personal safety and environmental control

Examples of covered adaptive equipment:

Wheelchair-accessible communication devices (AAC)

Shower chairs, grab bars, and transfer benches

Adaptive eating utensils or reachers

Smart home voice-controlled systems for individuals with mobility impairments

Specialized bedding, pressure relief cushions, and lift chairs

Environmental control units (ECUs) for lights, doors, alarms

Note: All equipment must be medically necessary, functionally justified, and listed in the individual's PCSP.

3. PROVIDER APPROVAL & LICENSING REQUIREMENTS

Prerequisites:

Register your business with the Washington Secretary of State

Obtain an EIN and Type 2 NPI

Enroll as a Medicaid provider via the ProviderOne portal

Contract with DDA or ALTSA as an Adaptive Equipment provider

Maintain liability insurance and staff background check clearances

If manufacturing or modifying equipment, comply with FDA standards and durable medical equipment (DME) regulations

Note: Adaptive equipment providers may also be durable medical equipment (DME) suppliers, occupational therapists, or technology vendors with rehab/assistive tech experience.

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business, secure EIN and NPI
Step 2: Apply to DDA or ALTSA as a Qualified Provider
Step 3: Enroll in ProviderOne with appropriate taxonomy (e.g., DME supplier, rehab equipment)
Step 4: Develop and submit a Policy & Procedure Manual for adaptive equipment services
Step 5: Submit background checks and proof of insurance
Step 6: Begin accepting referrals from case managers after authorization

5. REQUIRED DOCUMENTATION

Medicaid provider approval through ProviderOne

DDA or ALTSA contract as an equipment provider

Policy & Procedure Manual including:

Needs assessment and equipment selection process

Coordination with therapists or prescribers

Client education and training on device usage

Maintenance and replacement protocols

Consent, HIPAA, and grievance policies

Delivery, installation, and service verification forms

Documentation templates for equipment logs and reimbursement claims

6. STAFFING REQUIREMENTS

Role: Equipment Specialist / Technician
Requirements: Experience with assistive devices and vendor certifications for repair, fitting, or installation

Role: Occupational/Physical Therapist (optional, for clinical justification)
Responsibilities: Evaluate individual needs, recommend appropriate devices

Role: Program Administrator / Documentation Lead
Responsibilities: Coordinates authorizations, tracks inventory, and ensures billing compliance

All staff must complete:

HIPAA and confidentiality training

Safety protocols and device-specific training

Abuse prevention and emergency response training

Background checks and required state-mandated certifications

7. MEDICAID PROGRAMS THAT COVER ADAPTIVE EQUIPMENT

Authorized under:

Basic Plus Waiver – Up to the individual’s annual service cap

Core Waiver – As part of a comprehensive support plan

Individual and Family Services (IFS) Waiver – Must meet health and safety needs

Community First Choice (CFC) – Limited to support ADLs, if part of the CFC benefit package

Apple Health (State Plan) – For DME with physician’s order and clinical justification

Each item must be pre-approved and must not duplicate equipment already funded by another source.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Enrollment Setup
Timeline: 2–4 weeks

Phase: DDA or ALTSA Contracting & ProviderOne Enrollment
Timeline: 1–2 months

Phase: Policy Development & Staff Credentialing
Timeline: 2–3 weeks

Phase: Start of Service
Timeline: Begins after referral and equipment approval

9. CONTACT INFORMATION

Health Care Authority (HCA)
Website: https://www.hca.wa.gov

Developmental Disabilities Administration (DDA)
Website: https://www.dshs.wa.gov/dda

Aging and Long-Term Support Administration (ALTSA)
Website: https://www.dshs.wa.gov/altsa

ProviderOne Portal (Medicaid Billing)
Website: https://www.waproviderone.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON ADAPTIVE EQUIPMENT PROVIDER
WCG helps equipment vendors, tech specialists, and clinical teams launch Medicaid-compliant adaptive equipment services.

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Scope of Work:

Medicaid and DDA enrollment guidance

Adaptive Equipment Policy & Procedure Manual

Needs assessment templates and delivery checklists

Consent, warranty, and service verification forms

HIPAA and grievance policy documents

Equipment inventory tracking and billing tools

SKILLED NURSING SERVICES PROVIDER IN WASHINGTON
DELIVERING LICENSED NURSING CARE TO SUPPORT MEDICAL STABILITY, INDEPENDENCE, AND QUALITY OF LIFE IN HOME AND COMMUNITY SETTINGS

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Skilled Nursing Services in Washington provide licensed clinical care to individuals with complex medical needs who require ongoing monitoring, treatment, or rehabilitation. These services are critical for individuals with chronic conditions, disabilities, or after hospitalization—allowing them to receive medical care safely at home or in community-based settings, rather than in institutions.

Skilled nursing is covered under Apple Health (Washington Medicaid) as both a State Plan benefit and through Home and Community-Based Services (HCBS) waivers, including the Community First Choice (CFC) program and DDA waivers (e.g., Core, Basic Plus).

Oversight is shared by the Washington State Health Care Authority (HCA), Department of Social and Health Services (DSHS), and the Department of Health (DOH).

1. GOVERNING AGENCIES

Agency: Washington State Department of Health (DOH)
Role: Licenses Home Health Agencies and individual nurses; ensures clinical practice standards and nursing regulations.

Agency: Health Care Authority (HCA)
Role: Manages Apple Health and Medicaid reimbursement for nursing services.

Agency: Developmental Disabilities Administration (DDA)
Role: Authorizes nursing services for waiver participants based on medical necessity.

Agency: Department of Social and Health Services (DSHS)
Role: Manages caregiver supports, provider credentialing, and training for in-home services.

2. SKILLED NURSING SERVICES OVERVIEW

These services involve licensed nurses (RNs or LPNs) providing medically necessary interventions in home or community-based settings under a physician's order.

Examples of covered skilled nursing care include:

Medication administration (including injections, IVs)

Wound care and pressure ulcer management

Catheter and ostomy care

Respiratory therapy (trach or ventilator support)

Chronic disease management and health monitoring

Pre/post-operative care

Education for patients and caregivers

Clinical documentation and plan of care adherence

All nursing care must be prescribed by a physician and documented under a Plan of Care (POC).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites (Agency):

Register business with the Washington Secretary of State

Obtain an EIN and Type 2 NPI

Apply for a Home Health Agency license through DOH (if billing under agency model)

Complete ProviderOne enrollment as a Medicaid provider

Secure malpractice, liability, and worker’s compensation insurance

Develop a Skilled Nursing Policy & Procedure Manual per CMS and DOH standards

Prerequisites (Individual Nurses):

Active Washington RN or LPN license

Medicaid provider number

CPR certification and background check clearance

Signed agreements to provide care under physician orders

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI
Step 2: Apply for DOH Home Health or Nurse Delegation agency license (if applicable)
Step 3: Enroll with ProviderOne under correct taxonomy (individual or agency)
Step 4: Submit credentials, insurance, and supervisory agreements
Step 5: Coordinate with DDA or case managers for referrals
Step 6: Begin services upon physician order and POC authorization

5. REQUIRED DOCUMENTATION

Business registration, EIN, NPI

DOH Home Health license (if agency model)

ProviderOne enrollment confirmation

Skilled Nursing Policy & Procedure Manual including:

Scope of practice for RN and LPN

Physician order processing and POC development

Medication administration and documentation protocols

Infection control, PPE, and wound care procedures

Shift documentation, charting, and communication templates

HIPAA, incident reporting, and emergency response plans

Staff credentialing and continuing education logs

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements:

Current WA State RN license

Oversees assessments, plan of care, and medication administration

May supervise LPNs or Home Health Aides

Role: Licensed Practical Nurse (LPN)
Requirements:

WA State LPN license

Provides direct nursing care under RN supervision

Role: Nursing Supervisor / Administrator (if agency model)
Responsibilities:

Ensures quality assurance, staff oversight, and compliance

All staff must complete:

HIPAA, abuse prevention, and documentation training

Universal precautions and infection control

CPR certification and annual skills competency

7. MEDICAID PROGRAMS THAT COVER SKILLED NURSING

Skilled Nursing is covered under:

Apple Health State Plan Medicaid – Short-term post-acute care under physician orders

Community First Choice (CFC) – Ongoing skilled tasks for medically fragile individuals

Basic Plus Waiver – Periodic skilled care in family settings

Core Waiver – Long-term nursing supports for individuals in residential or intensive settings

Private Duty Nursing (PDN) – For individuals needing >4 hours/day of nursing care (subject to eligibility)

All services must be listed in the participant’s Plan of Care (POC) or PCSP, with medical necessity documentation.

8. TIMELINE TO LAUNCH

Phase: Business Setup & Licensing (agency model)
Timeline: 1–2 months

Phase: DOH Application & ProviderOne Enrollment
Timeline: 2–3 months

Phase: Policy Manual & Credentialing
Timeline: 2–4 weeks

Phase: Referrals & Service Start
Timeline: Begins upon POC authorization and staffing

9. CONTACT INFORMATION

Washington State Department of Health (DOH)
Website: https://www.doh.wa.gov

Washington Health Care Authority (HCA)
Website: https://www.hca.wa.gov

Developmental Disabilities Administration (DDA)
Website: https://www.dshs.wa.gov/dda

ProviderOne Enrollment Portal
Website: https://www.waproviderone.org

Nursing Care Quality Assurance Commission
Website: https://nursing.wa.gov

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON SKILLED NURSING PROVIDER
WCG helps RNs, LPNs, and home health agencies launch compliant skilled nursing services with tailored policy manuals, billing systems, and clinical workflows.

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Scope of Work:

ProviderOne and DOH licensing support

Skilled Nursing Policy & Procedure Manual

POC templates, medication logs, and MARs

Charting, shift note, and incident report tools

Staff credentialing trackers and supervision templates

Medicaid billing documentation and compliance checklists

COMMUNITY FIRST CHOICE (CFC) SERVICES PROVIDER IN WASHINGTON
SUPPORTING INDEPENDENCE THROUGH PERSON-CENTERED PERSONAL CARE, HOUSEHOLD ASSISTANCE, AND HEALTH-RELATED TASKS UNDER MEDICAID

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Community First Choice (CFC) is a Medicaid State Plan benefit in Washington that provides long-term services and supports (LTSS) for individuals who need assistance with activities of daily living (ADLs) and health-related tasks to remain in their homes or communities, rather than institutional settings.

CFC is administered by the Washington State Health Care Authority (HCA) in partnership with the Department of Social and Health Services (DSHS) and delivered under the Apple Health Medicaid program. It is not a waiver, but a State Plan option available to individuals meeting functional and financial eligibility requirements.

1. GOVERNING AGENCIES

Agency: Health Care Authority (HCA)
Role: Administers the CFC program under the Medicaid State Plan and oversees provider payments.

Agency: Department of Social and Health Services (DSHS) – Aging and Long-Term Support Administration (ALTSA)
Role: Manages case management, assessments, and CFC provider credentialing.

Agency: Developmental Disabilities Administration (DDA)
Role: Coordinates services for individuals with intellectual and developmental disabilities who also qualify for CFC.

2. COMMUNITY FIRST CHOICE SERVICES OVERVIEW

CFC services are tailored to the individual’s needs and authorized through a person-centered assessment conducted by a DSHS or DDA case manager.

Covered CFC services include:

Personal care support (bathing, dressing, grooming, toileting)

Household tasks (laundry, light cleaning, meal prep)

Health-related tasks delegated by licensed healthcare professionals

Emergency response systems

Skills acquisition training (e.g., self-care, safety skills)

Assistive technology and environmental adaptations

Personal Emergency Response Systems (PERS)

All services are captured in the individual’s Service Summary and authorized before delivery.

3. PROVIDER APPROVAL & LICENSING REQUIREMENTS

Prerequisites (Agency or Individual):

Register with the Washington Secretary of State (if agency)

Obtain an EIN and Type 2 NPI

Enroll in Medicaid via ProviderOne under the CFC taxonomy

Complete the DSHS contracting process for Individual Providers (IPs) or Agency Providers

Submit to background checks and credential verification

Create a Community First Choice Policy & Procedure Manual

Agencies must also meet training and quality assurance standards for home care.

4. WASHINGTON CFC PROVIDER ENROLLMENT PROCESS

Step 1: Register business (if agency), obtain EIN and NPI
Step 2: Apply to DSHS as a CFC provider (Individual or Agency model)
Step 3: Enroll in ProviderOne for Medicaid billing
Step 4: Complete background checks and staff credentialing
Step 5: Participate in required DSHS CFC training programs
Step 6: Begin services upon referral and service authorization

5. REQUIRED DOCUMENTATION

DSHS contract and ProviderOne enrollment confirmation

CFC Policy & Procedure Manual including:

Client rights, confidentiality, and informed consent

Personal care service delivery plans

Staff training documentation and supervision protocols

Incident reporting and emergency procedures

Documentation logs (daily tasks, notes, time-in/time-out)

Health-related task delegation and monitoring (if applicable)

6. STAFFING REQUIREMENTS

Role: Home Care Aide / CFC Caregiver
Requirements:

Must be certified as a Home Care Aide (HCA) or be exempt based on family relationship

Complete 75-hour training and pass certification exam (unless exempt)

Pass DSHS background checks and tuberculosis screening

Role: Supervising RN (if providing delegated health-related tasks)
Responsibilities:

Train and supervise caregivers on delegated tasks (e.g., insulin, tube feeding)

All staff must complete:

HIPAA, abuse prevention, and safety training

Ongoing skills evaluation and compliance refreshers

Documentation and service delivery tracking

7. CFC ELIGIBILITY & SERVICE AUTHORIZATION

To receive CFC services, individuals must:

Be Medicaid-eligible under Apple Health

Meet institutional level of care per DSHS assessment

Reside in a community setting (home, shared housing, etc.)

Be assessed by a case manager who develops their Service Summary

Services are delivered at no cost to the client, with no waiting list unlike waiver programs.

8. TIMELINE TO LAUNCH

Phase: Business Setup & Medicaid Enrollment
Timeline: 2–4 weeks

Phase: DSHS Contracting & Credentialing
Timeline: 4–6 weeks

Phase: Policy Development & Staff Training
Timeline: 2–3 weeks

Phase: Client Referral & Service Start
Timeline: Begins after Service Summary and authorization from case manager

9. CONTACT INFORMATION

Health Care Authority (HCA) – CFC Program
Website: https://www.hca.wa.gov

Department of Social and Health Services (DSHS) – ALTSA
Website: https://www.dshs.wa.gov/altsa

ProviderOne Portal (Medicaid Billing)
Website: https://www.waproviderone.org

Home Care Aide Certification – DOH
Website: https://www.doh.wa.gov

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON CFC PROVIDER
WCG supports caregivers and agencies in launching Community First Choice services with streamlined compliance, caregiver training, and documentation systems.

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Scope of Work:

ProviderOne and DSHS contracting assistance

CFC-compliant Policy & Procedure Manual

Staff onboarding forms and credentialing templates

Care logs, service summaries, and time documentation tools

HIPAA, grievance, and incident report policies

Tools for managing delegated tasks under nurse supervision

ADULT DAY HEALTH SERVICES PROVIDER IN WASHINGTON
OFFERING MEDICALLY SUPERVISED DAYTIME CARE TO PROMOTE HEALTH, ENGAGEMENT, AND INDEPENDENCE FOR OLDER ADULTS AND INDIVIDUALS WITH DISABILITIES

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Adult Day Health (ADH) Services in Washington provide structured daytime care in a community-based setting for individuals who have chronic health conditions, physical or cognitive impairments, or need ongoing rehabilitation or nursing oversight. These programs support individuals’ ability to remain at home while receiving essential services like nursing care, therapy, and social engagement.

ADH is covered under Washington Apple Health (Medicaid) through the Community Options Program Entry System (COPES) Waiver, PACE (Program of All-Inclusive Care for the Elderly), and the Community First Choice (CFC) program. Oversight is provided by the Washington State Department of Social and Health Services (DSHS) and Health Care Authority (HCA).

1. GOVERNING AGENCIES

Agency: Washington State Department of Social and Health Services (DSHS) – Aging and Long-Term Support Administration (ALTSA)
Role: Oversees licensing, service authorization, and care coordination for Medicaid clients receiving ADH.

Agency: Health Care Authority (HCA)
Role: Administers Apple Health, sets policy for Medicaid funding, and oversees Managed Care contracts.

Agency: Washington State Department of Health (DOH)
Role: Licenses ADH facilities under specific health care facility guidelines.

2. ADULT DAY HEALTH SERVICES OVERVIEW

Adult Day Health services integrate health, rehabilitation, and psychosocial services into a group setting during the day. These programs are ideal for individuals with complex care needs who live at home but require:

Nursing services

Medication management

Physical, occupational, or speech therapy

Social work or counseling

Daily health monitoring and chronic condition support

Nutritional counseling and meal services

Socialization and recreational activities

Each client must have a Person-Centered Service Plan (PCSP) developed in collaboration with a case manager and an interdisciplinary team.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business with the Washington Secretary of State

Obtain an EIN and Type 2 NPI

Apply for Adult Day Health Center licensure through the Washington Department of Health (DOH)

Enroll as a Medicaid provider via ProviderOne

Develop a comprehensive ADH Services Policy & Procedure Manual

Secure a facility that meets licensing and ADA accessibility standards

Complete background checks and credentialing for all staff

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI
Step 2: Secure a licensed, accessible facility with required medical and therapy equipment
Step 3: Apply for DOH Adult Day Health licensure
Step 4: Enroll in Medicaid via the ProviderOne portal
Step 5: Establish referral relationships with DSHS case managers
Step 6: Hire clinical, administrative, and program staff
Step 7: Begin services once a participant’s PCSP is approved

5. REQUIRED DOCUMENTATION

Secretary of State registration, EIN, and NPI

DOH ADH center license and fire safety inspection

Medicaid enrollment confirmation

ADH Policy & Procedure Manual including:

Nursing and therapy protocols

Medication administration records (MARs)

Daily health tracking and incident reporting systems

Client intake forms and PCSP tracking

Staff orientation, training logs, and licensure verification

Participant rights, HIPAA, and infection control

Emergency response and evacuation plans

Activity planning and meal tracking logs

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements:

Active Washington license

Oversees clinical care, medication management, and health monitoring

Role: Social Worker / Program Manager
Responsibilities:

Provides counseling, discharge planning, and support with psychosocial needs

Role: Therapists (PT, OT, SLP)
Requirements:

Licensed in Washington; must document progress and therapy plans

Role: Activity Coordinator
Responsibilities:

Plans and facilitates meaningful group activities

Role: Direct Care Staff / Aides
Requirements:

CPR/First Aid certified; trained in ADL support and safety

All staff must complete:

TB testing and background checks

HIPAA and elder abuse prevention

Emergency preparedness training

Annual skills assessments and continuing education

7. MEDICAID PROGRAMS THAT COVER ADH

COPES Waiver – For individuals who meet nursing facility level of care

Community First Choice (CFC) – May fund ADH for clients eligible for Apple Health and personal care

PACE Programs – Fully integrated Medicare-Medicaid models may provide ADH

Medically Needy Spenddown / State Plan Personal Care – For those who don’t qualify under a waiver but need services

Referrals and authorizations are coordinated through DSHS or MCOs, depending on the client’s coverage.

8. TIMELINE TO LAUNCH

Phase: Business Setup & Facility Preparation
Timeline: 1–2 months

Phase: DOH Licensing & Medicaid Enrollment
Timeline: 2–4 months

Phase: Staff Hiring & Training
Timeline: 4–6 weeks

Phase: Participant Intake & Service Launch
Timeline: Begins upon PCSP approval and team assignment

9. CONTACT INFORMATION

Washington State Department of Health (DOH)
Website: https://www.doh.wa.gov

Department of Social and Health Services (DSHS) – ALTSA
Website: https://www.dshs.wa.gov/altsa

Health Care Authority (HCA)
Website: https://www.hca.wa.gov

ProviderOne Medicaid Portal
Website: https://www.waproviderone.org

DSHS Long-Term Care Services Directory
Website: https://www.dshs.wa.gov/altsa/resources

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON ADULT DAY HEALTH PROVIDER
WCG supports new ADH providers in launching state-compliant centers with a focus on medical coordination, daily engagement, and regulatory excellence.

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Scope of Work:

Facility planning and DOH licensing support

Medicaid enrollment and ProviderOne setup

Policy & Procedure Manual tailored for ADH services

Clinical documentation templates and nursing logs

Activity schedules, meal service plans, and daily records

Staff credentialing systems and training checklists

PCSP tracking tools and interdisciplinary care plan formats

ASSISTIVE TECHNOLOGY SERVICES PROVIDER IN WASHINGTON
DELIVERING TOOLS, EQUIPMENT, AND TRAINING TO ENHANCE INDEPENDENCE, SAFETY, AND COMMUNICATION FOR INDIVIDUALS WITH DISABILITIES

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Assistive Technology (AT) Services in Washington support individuals with disabilities by providing devices, adaptations, and training that help them function more independently at home, school, work, or in the community. These services enable people to perform tasks they might otherwise be unable to do due to physical, sensory, or cognitive limitations.

AT services are covered under Washington Medicaid, specifically through Home and Community-Based Services (HCBS) Waivers managed by the Developmental Disabilities Administration (DDA) and the Health Care Authority (HCA). AT may also be included under the Community First Choice (CFC) program and through school-based or vocational programs depending on the setting.

1. GOVERNING AGENCIES

Agency: Developmental Disabilities Administration (DDA)
Role: Authorizes assistive technology for waiver participants and oversees provider standards.

Agency: Health Care Authority (HCA)
Role: Manages Medicaid funding through Apple Health and defines AT as a State Plan or waiver service.

Agency: Department of Social and Health Services (DSHS)
Role: Administers Medicaid HCBS waiver services and contracts with AT providers.

2. ASSISTIVE TECHNOLOGY SERVICES OVERVIEW

Assistive Technology includes both the equipment and the related services required to select, obtain, and train individuals and caregivers in the use of such equipment.

Examples of covered AT include:

Communication devices (e.g., speech-generating devices)

Hearing or vision aids (if not already covered under other benefits)

Environmental controls (e.g., voice-activated lights, adaptive remotes)

Computer access tools (adaptive keyboards, switches, screen readers)

Mounting systems or custom adaptations

Smart home safety devices (e.g., fall detectors, medication reminders)

AT-related services may include:

Evaluations and needs assessments

Device customization or fabrication

Fitting, setup, and installation

Training for individuals, families, and caregivers

Repairs and maintenance for approved devices

All services must be included in an individual’s Person-Centered Service Plan (PCSP) and pre-authorized by DDA or an MCO, depending on waiver type.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Washington Secretary of State

Obtain an EIN and Type 2 NPI

Apply to become a DDA-approved Assistive Technology Provider

Enroll in Medicaid through the ProviderOne portal

Develop a Policy & Procedure Manual for Assistive Technology services

For suppliers of durable medical equipment (DME), apply for a DME license if needed

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN and NPI
Step 2: Submit application to DDA as an AT provider
Step 3: Enroll in Medicaid via ProviderOne for billing authorization
Step 4: Document qualifications for assessments, customization, or training
Step 5: Establish documentation systems and obtain referrals
Step 6: Begin services upon authorization in the individual’s PCSP

5. REQUIRED DOCUMENTATION

Business registration, EIN, and NPI

DDA provider qualification and Medicaid enrollment proof

Policy & Procedure Manual including:

AT evaluation, customization, and installation guidelines

Staff credentialing and training logs

Participant rights, HIPAA, and consent documentation

Repair and maintenance tracking

Incident reporting and safe-use documentation

Coordination templates for therapists, physicians, or educators

6. STAFFING REQUIREMENTS

Role: Assistive Technology Specialist / Consultant
Qualifications:

Relevant experience in occupational therapy, rehab engineering, assistive tech, or special education

Certifications preferred: RESNA ATP (Assistive Technology Professional) or OT/PT license

Role: Technician / Installer (if applicable)
Responsibilities:

Must follow installation and safety procedures

Basic familiarity with adaptive and smart tech systems

All staff must complete:

HIPAA and confidentiality training

Participant rights and informed consent procedures

Emergency protocols and device-specific training

Ongoing technical and clinical competency evaluations

7. MEDICAID WAIVERS & PROGRAMS THAT COVER AT

Assistive Technology is reimbursable under:

Basic Plus Waiver – For individuals living in family or supported settings

Core Waiver – For clients with complex needs requiring long-term AT use

Individual and Family Services (IFS) Waiver – May cover AT with an annual budget cap

Community First Choice (CFC) – Certain AT items covered for functional independence

School-based or VR Programs – May co-fund assessments or devices for education or employment

Each request must include medical necessity documentation and be approved as part of the PCSP.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Qualification
Timeline: 2–3 weeks

Phase: DDA Approval & Medicaid Enrollment
Timeline: 4–6 weeks

Phase: P&P Manual Development and Staffing
Timeline: 2–3 weeks

Phase: Referral Coordination & Service Launch
Timeline: Begins upon authorization and service plan integration

9. CONTACT INFORMATION

Developmental Disabilities Administration (DDA)
Website: https://www.dshs.wa.gov/dda

Health Care Authority (HCA)
Website: https://www.hca.wa.gov

ProviderOne Medicaid Portal
Website: https://www.waproviderone.org

RESNA (Assistive Technology Certification)
Website: https://www.resna.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON ASSISTIVE TECHNOLOGY PROVIDER
WCG helps innovative providers and tech consultants establish compliant AT services, from evaluation tools to Medicaid billing.

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Scope of Work:

DDA and ProviderOne enrollment support

AT Policy & Procedure Manual tailored to tech delivery

Client intake forms, service logs, and device authorization templates

Customization and tracking tools for high-tech/low-tech AT

Staff credentialing and RESNA ATP prep guidance

HIPAA and medical necessity documentation templates

BEHAVIORAL HEALTH SERVICES PROVIDER IN WASHINGTON
SUPPORTING INDIVIDUALS THROUGH MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES TO PROMOTE WELL-BEING AND COMMUNITY STABILITY

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Behavioral Health Services in Washington offer mental health treatment, substance use disorder (SUD) support, and therapeutic interventions to individuals with emotional, behavioral, or psychiatric needs. Services aim to enhance individual stability, recovery, and quality of life, while reducing the need for inpatient or emergency interventions.

Washington State operates an integrated managed care system under Apple Health (Medicaid), through which behavioral health services are coordinated by Managed Care Organizations (MCOs) and overseen by the Health Care Authority (HCA). Services may also be accessed through Behavioral Health Administrative Services Organizations (BH-ASOs) for individuals not enrolled in Medicaid.

1. GOVERNING AGENCIES

Agency: Health Care Authority (HCA)
Role: Administers behavioral health Medicaid benefits, contracts with MCOs and BH-ASOs, and sets statewide clinical and regulatory standards.

Agency: Department of Health (DOH)
Role: Licenses behavioral health agencies and credentials behavioral health professionals.

Agency: Managed Care Organizations (MCOs)
Role: Coordinate and reimburse Medicaid behavioral health services in designated service regions.

Agency: Behavioral Health Administrative Services Organizations (BH-ASOs)
Role: Manage crisis, involuntary treatment, and services for non-Medicaid clients.

2. BEHAVIORAL HEALTH SERVICES OVERVIEW

Washington behavioral health services include mental health, substance use disorder (SUD), and co-occurring treatment, such as:

Mental Health Therapy – Individual, family, or group counseling

Psychiatric Services – Medication management, assessments, and follow-up

Peer Support – Recovery coaching by certified peers with lived experience

Crisis Services – Mobile crisis teams, stabilization beds, and involuntary treatment evaluation

SUD Treatment – Outpatient, intensive outpatient, medication-assisted treatment (MAT)

Case Management – Support with housing, employment, and community integration

School-Based or Wraparound Services – For youth and adolescents

Services must be medically necessary, supported by a Behavioral Health Assessment, and follow an individualized treatment plan.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Washington Secretary of State

Obtain EIN and Type 2 NPI

Apply for a Behavioral Health Agency license through DOH's Online Licensing (OILS)

Enroll with HCA for Medicaid billing

Contract with applicable Managed Care Organizations (MCOs) in your region

Submit to background checks, quality monitoring, and staff credentialing

Develop a Behavioral Health Policy & Procedure Manual aligned with WAC 246-341

Note: Clinical supervision and service delivery models must meet state licensure standards.

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN and NPI
Step 2: Apply for Behavioral Health Agency license via DOH’s OILS system
Step 3: Enroll in ProviderOne for Medicaid billing under appropriate taxonomy
Step 4: Contract with regional MCOs and/or BH-ASOs
Step 5: Finalize Policy Manual and pass DOH pre-licensure inspection (if required)
Step 6: Begin delivering services upon contract execution and credentialing

5. REQUIRED DOCUMENTATION

DOH Behavioral Health Agency license

Medicaid ProviderOne enrollment confirmation

MCO or BH-ASO provider agreements

Behavioral Health Policy & Procedure Manual including:

Intake, assessment, and treatment planning

Crisis protocols and risk assessments

Co-occurring disorder treatment models

Peer support standards and credential tracking

Patient rights, grievance and complaint process

HIPAA compliance and documentation templates

Clinical supervision, CE tracking, and credential validation logs

6. STAFFING REQUIREMENTS

Role: Licensed Mental Health Professional (LMHP)
Requirements: LICSW, LMHC, LMFT, or psychologist licensed by DOH

Role: Substance Use Disorder Professional (SUDP)
Requirements: WA DOH credential, 40+ hours of annual CE required

Role: Psychiatric Provider (ARNP, MD/DO)
Responsibilities: Prescribes and monitors psychotropic medications

Role: Peer Counselor / Recovery Coach
Requirements: Certified Peer Counselor (CPC) credential and supervised practice

All staff must complete:

HIPAA and documentation training

Clinical supervision and skills competency

Cultural competency and trauma-informed care training

Suicide prevention and de-escalation protocols

7. MEDICAID PROGRAMS THAT COVER BEHAVIORAL HEALTH

Behavioral health services are covered under:

Apple Health Integrated Managed Care – All Medicaid MCOs coordinate mental health and SUD care

BH-ASOs – Serve Medicaid in crisis settings and non-Medicaid clients

Youth Mental Health and Wraparound with Intensive Services (WISe) – High-intensity support for minors

Crisis and Involuntary Treatment Act (ITA) services – Available regardless of payer source

8. TIMELINE TO LAUNCH

Phase: Business Setup & Licensing Prep
Timeline: 4–8 weeks

Phase: DOH Behavioral Health License & Medicaid Enrollment
Timeline: 2–4 months

Phase: MCO Contracts & Staff Credentialing
Timeline: 1–2 months

Phase: Launch of Services
Timeline: Begins upon execution of payer contracts and clinical readiness

9. CONTACT INFORMATION

Washington State Department of Health – Behavioral Health Licensing
Website: https://www.doh.wa.gov

Washington Health Care Authority (HCA)
Website: https://www.hca.wa.gov

ProviderOne Portal
Website: https://www.waproviderone.org

Managed Care Organization Contacts (Apple Health MCOs)
Website: https://www.hca.wa.gov/free-or-low-cost-health-care/apple-health-managed-care

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON BEHAVIORAL HEALTH PROVIDER
WCG assists agencies and private practices in launching Medicaid-eligible behavioral health programs across Washington State.

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Scope of Work:

DOH licensing application and documentation support

Behavioral Health Policy & Procedure Manual aligned with WAC 246-341

MCO and BH-ASO contracting guidance

Client assessment, treatment planning, and progress note templates

Staff credentialing packets, CE tracking, and supervision forms

HIPAA, crisis response, and documentation policies

COMMUNITY TRANSITION SERVICES PROVIDER IN WASHINGTON
SUPPORTING INDIVIDUALS AS THEY MOVE FROM INSTITUTIONAL SETTINGS INTO SAFE, STABLE, AND INDEPENDENT COMMUNITY LIVING ARRANGEMENTS

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Community Transition Services in Washington help individuals transition from nursing facilities, intermediate care facilities, or institutional settings into home and community-based environments. These services cover the essential non-recurring expenses associated with setting up a household, enabling individuals to live independently with dignity and support.

These services are authorized under several Home and Community-Based Services (HCBS) Waivers, including the Basic Plus Waiver, Core Waiver, and Community Options Program Entry System (COPES). Oversight is provided by the Department of Social and Health Services (DSHS) through the Aging and Long-Term Support Administration (ALTSA) and the Developmental Disabilities Administration (DDA), with Medicaid funding from the Health Care Authority (HCA).

1. GOVERNING AGENCIES

Agency: Department of Social and Health Services (DSHS) – ALTSA
Role: Manages community transition under long-term care waivers for aging adults and physically disabled individuals.

Agency: Developmental Disabilities Administration (DDA)
Role: Oversees transitions for individuals with intellectual and developmental disabilities through DDA waivers.

Agency: Health Care Authority (HCA)
Role: Provides Medicaid funding under Apple Health and manages program compliance.

2. COMMUNITY TRANSITION SERVICES OVERVIEW

Community Transition Services cover one-time, setup-related costs to help individuals successfully move into a home in the community.

Examples of allowable transition expenses:

Security deposits and initial rent

Utility deposits (electric, gas, water, phone)

Essential furnishings and household items

Moving expenses and initial food supplies

Setup of basic appliances (if not provided in the home)

Health and safety items (e.g., locks, fire extinguishers, shower chairs)

All purchases must be pre-approved and listed in the participant’s Person-Centered Service Plan (PCSP).

3. PROVIDER APPROVAL & LICENSING REQUIREMENTS

Prerequisites:

Register business with the Washington Secretary of State

Obtain an EIN and Type 2 NPI

Qualify as a DDA or ALTSA Community Transition Provider

Enroll in Medicaid through the ProviderOne Portal

Maintain liability insurance and submit to background checks

Develop a Transition Services Policy & Procedure Manual

Providers may be case managers, coordinators, or agencies experienced in housing, social work, or care transitions.

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN and NPI
Step 2: Apply with DSHS/DDA as a Community Transition Provider
Step 3: Enroll in ProviderOne as a Medicaid billing provider
Step 4: Submit policy manual, service outlines, and staff credentials
Step 5: Coordinate with case managers to receive referrals
Step 6: Conduct home setup assessments and provide pre-approved goods or services

5. REQUIRED DOCUMENTATION

DSHS or DDA provider approval

ProviderOne enrollment confirmation

Policy & Procedure Manual including:

Intake and home readiness checklists

Transition planning forms

Purchase approval, invoicing, and receipts protocol

Staff background checks and training logs

Participant rights, HIPAA policies, and incident response

Sample documentation logs for reimbursements

6. STAFFING REQUIREMENTS

Role: Transition Coordinator / Specialist
Requirements:

Background in housing, case management, or disability services

Strong knowledge of home setup standards, Medicaid compliance, and local housing laws

Must pass background checks and be HIPAA trained

Role: Administrative/Logistics Support (Optional)
Responsibilities:

Track expenses, gather receipts, schedule vendors, and maintain documentation

All staff must complete:

HIPAA and client confidentiality training

Person-centered planning and abuse prevention

Financial tracking and fraud prevention training

7. MEDICAID PROGRAMS THAT COVER COMMUNITY TRANSITION

Community Transition Services are available under:

Basic Plus Waiver – For DDA clients moving to supported living or family homes

Core Waiver – For individuals transitioning from ICF/ID or intensive residential care

COPES Program – For older adults or physically disabled individuals leaving nursing homes

Roads to Community Living (RCL) – Time-limited demonstration project for nursing facility transitions

Foundational Community Supports (FCS) – May be paired with transition services for housing support

Each program has maximum allowable spending limits, usually capped at $850–$2,000, depending on waiver rules.

8. TIMELINE TO LAUNCH

Phase: Business Formation & NPI Registration
Timeline: 1–2 weeks

Phase: Provider Qualification (DSHS/DDA) & Medicaid Enrollment
Timeline: 1–2 months

Phase: Staff Onboarding & Policy Manual Finalization
Timeline: 2–3 weeks

Phase: Referrals & Service Delivery
Timeline: Begins upon participant approval and service plan authorization

9. CONTACT INFORMATION

DSHS – Aging and Long-Term Support Administration (ALTSA)
Website: https://www.dshs.wa.gov/altsa

Developmental Disabilities Administration (DDA)
Website: https://www.dshs.wa.gov/dda

Health Care Authority (HCA)
Website: https://www.hca.wa.gov

ProviderOne Portal (Billing)
Website: https://www.waproviderone.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON TRANSITION SERVICES PROVIDER
WCG helps housing-focused organizations and care professionals launch compliant transition support programs to assist individuals in safely returning to the community.

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Scope of Work:

Medicaid and DDA/ALTSA enrollment support

Transition Planning & Documentation toolkit

Policy Manual tailored to household setup services

HIPAA, consent, and fraud prevention policies

Expense tracking, purchase log, and invoice templates

Staff onboarding documents and incident report forms

ADULT FAMILY HOME (AFH) PROVIDER IN WASHINGTON
DELIVERING PERSONALIZED, ROUND-THE-CLOCK CARE IN A RESIDENTIAL SETTING TO SUPPORT AGING ADULTS AND INDIVIDUALS WITH DISABILITIES

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Adult Family Homes (AFHs) in Washington offer 24-hour care, supervision, and assistance with activities of daily living (ADLs) in a licensed home-based setting. Each AFH can serve up to six residents, allowing for an intimate, community-centered alternative to institutional care. AFHs are ideal for individuals who need support with personal care, medication management, and basic health-related services while maintaining independence and social engagement.

AFHs are licensed and regulated by the Department of Social and Health Services (DSHS) and may receive Medicaid reimbursement through Apple Health’s Long-Term Services and Supports (LTSS), including programs like COPES, Community First Choice (CFC), and Medicaid Alternative Care (MAC).

1. GOVERNING AGENCIES

Agency: DSHS – Residential Care Services (RCS)
Role: Licenses and inspects Adult Family Homes, enforces compliance with WAC 388-76.

Agency: DSHS – Aging and Long-Term Support Administration (ALTSA)
Role: Manages Medicaid-funded care for older adults and people with disabilities in residential settings.

Agency: Health Care Authority (HCA)
Role: Administers Medicaid reimbursement for LTSS under Apple Health.

2. ADULT FAMILY HOME SERVICES OVERVIEW

AFHs provide a home-like setting with:

Personal care – Bathing, grooming, toileting, dressing

Medication administration and monitoring

Meal preparation – Including therapeutic diets

Laundry and housekeeping

Supervision and safety monitoring

Recreational and social activities

Support with transportation to appointments

Coordination with healthcare providers

Residents may include older adults, adults with physical disabilities, or adults with developmental/intellectual disabilities.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Be at least 21 years old and pass a DSHS background check

Complete the Adult Family Home Orientation Class

Identify a suitable home property that meets building and zoning requirements

Pass a home inspection by DSHS

Complete the 75-hour Adult Family Home Administrator Training

Submit an AFH license application through DSHS

Obtain liability insurance, business license, and register with ProviderOne

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Complete orientation and review WAC 388-76 regulations
Step 2: Submit AFH license application and background check
Step 3: Complete AFH Administrator Training and required certifications
Step 4: Pass environmental inspection and safety compliance review
Step 5: Enroll in ProviderOne as a Medicaid LTSS provider
Step 6: Accept referrals from case managers and start services

5. REQUIRED DOCUMENTATION

AFH license issued by DSHS

Proof of orientation and training completion

ProviderOne Medicaid enrollment confirmation

Policy & Procedure Manual including:

Resident admission and assessment process

Fire safety, evacuation, and infection control policies

Medication management and shift documentation logs

Abuse prevention, incident reporting, and HIPAA compliance

Menu plans, nutrition logs, and special diet documentation

Staff schedules and continuing education logs

Client rights and grievance forms

6. STAFFING REQUIREMENTS

Role: Adult Family Home Provider / Administrator
Requirements: Complete 75-hour training, be on-site or available 24/7, and provide hands-on care

Role: Caregivers / Staff
Requirements: Must complete caregiver certification, pass background checks, and receive ongoing training

Role: Nurse Consultant (if needed for RN-delegation tasks)
Requirements: Licensed RN available to supervise complex medical tasks

All staff must complete:

CPR/First Aid certification

Dementia and mental health training (if applicable)

Infection control and universal precautions

Abuse reporting and resident safety protocols

Annual continuing education (CE) hours per state guidelines

7. MEDICAID PROGRAMS THAT COVER AFH SERVICES

Services in AFHs may be reimbursed under:

COPES Waiver – For clients needing personal care in residential settings

Community First Choice (CFC) – Medicaid personal care program

Medicaid Alternative Care (MAC) – For unpaid caregivers supporting aging loved ones

Tailored Supports for Older Adults (TSOA) – For clients not yet eligible for Medicaid

DDA Core Waiver – For individuals with intellectual or developmental disabilities

8. TIMELINE TO LAUNCH

Phase: Orientation, Training & Licensing Application
Timeline: 1–3 months

Phase: Home Readiness & DSHS Inspection
Timeline: 1–2 months

Phase: ProviderOne Enrollment & Medicaid Contracting
Timeline: 30–60 days

Phase: Staff Hiring, Policy Finalization & Service Launch
Timeline: Begins after license issuance and provider activation

9. CONTACT INFORMATION

DSHS – Adult Family Home Licensing
Website: https://www.dshs.wa.gov/altsa/residential-care-services/adult-family-home-licensing

Washington Health Care Authority (HCA)
Website: https://www.hca.wa.gov

ProviderOne Portal (Billing & Enrollment)
Website: https://www.waproviderone.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON ADULT FAMILY HOME PROVIDER
WCG supports caregivers, families, and entrepreneurs in launching fully compliant Adult Family Homes, from home inspection to Medicaid reimbursement.

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Scope of Work:

Orientation and licensing application support

Administrator and staff credentialing assistance

Policy & Procedure Manual tailored to AFH standards

Inspection preparation checklist and home setup guide

Medicaid enrollment and ProviderOne documentation

Resident care plan templates and staff supervision tools

INDIVIDUAL AND FAMILY SERVICES (IFS) PROVIDER IN WASHINGTON
SUPPORTING INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES AND THEIR FAMILIES TO LIVE INDEPENDENTLY THROUGH CUSTOMIZED COMMUNITY-BASED SERVICES

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The Individual and Family Services (IFS) Waiver in Washington offers flexible, person-centered services and supports to individuals with intellectual and developmental disabilities (ID/DD) who live with their families or independently. The IFS program empowers individuals by helping them gain greater independence, while also supporting family caregivers in their essential roles.

This waiver is administered by the Developmental Disabilities Administration (DDA) under the Washington State Department of Social and Health Services (DSHS), with funding and oversight by the Washington State Health Care Authority (HCA).

1. GOVERNING AGENCIES

Agency: Developmental Disabilities Administration (DDA)
Role: Determines eligibility, authorizes services, and manages the delivery of IFS supports.

Agency: Health Care Authority (HCA)
Role: Provides Medicaid oversight and manages waiver compliance under Apple Health.

Agency: Department of Social and Health Services (DSHS)
Role: Coordinates provider credentialing and contracting processes.

2. IFS SERVICES OVERVIEW

IFS offers a menu of flexible, community-based services designed to support individuals with developmental disabilities in living safely and independently outside of institutional settings.

Approved services under IFS include:

Respite care (in-home or out-of-home)

Personal care

Supported employment and community engagement

Behavioral health stabilization

Assistive technology and adaptive equipment

Home and vehicle modifications

Specialized medical equipment and supplies

Peer mentoring, skills acquisition, and family training

Staff and family counseling

Service selections must align with the individual's Person-Centered Service Plan (PCSP) and are limited to an annual individualized budget.

3. PROVIDER APPROVAL & LICENSING REQUIREMENTS

Prerequisites:

Register business with the Washington Secretary of State

Obtain an EIN and Type 2 NPI

Enroll as a DDA Qualified Provider under the desired IFS services (e.g., respite, personal care, training)

Complete a ProviderOne Medicaid enrollment

Meet staff credentialing, background check, and training requirements

Develop an IFS Services Policy & Procedure Manual that meets DDA standards

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4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register your business and obtain EIN and NPI
Step 2: Apply to DDA for qualification as an IFS provider in selected service areas
Step 3: Enroll in ProviderOne for Medicaid billing
Step 4: Complete background checks, orientation, and training for staff
Step 5: Coordinate with DDA case managers for referrals and PCSP integration
Step 6: Launch services upon authorization and budget allocation

5. REQUIRED DOCUMENTATION

Business registration, EIN, and NPI

DDA service approval and ProviderOne enrollment confirmation

IFS Policy & Procedure Manual including:

Intake forms and PCSP coordination templates

Individualized support plan documentation tools

Staff orientation, training logs, and supervision procedures

Participant rights, HIPAA, and grievance procedures

Incident reporting, emergency response, and safety policies

Service tracking logs, billing records, and budget reconciliation tools

6. STAFFING REQUIREMENTS

Role: Direct Support Professional (DSP) / Respite Worker / Coach
Requirements:

Must pass background checks and be trained in abuse prevention, person-centered supports, and emergency response

Additional training required based on service type (e.g., medication assistance, behavioral support)

Role: Program Coordinator or Supervisor (Recommended)
Responsibilities:

Ensures quality assurance, staff supervision, service documentation, and communication with DDA case managers

All staff must complete:

Orientation and training required by DDA

Mandatory reporter and confidentiality training

Emergency preparedness and health & safety training

Annual continuing education (CE) or retraining

7. IFS WAIVER ELIGIBILITY & LIMITATIONS

IFS is available to individuals who:

Are eligible for DDA services

Are age 3 or older

Live in a family home or independently

Meet financial and functional eligibility for Medicaid

Do not receive services under other DDA waivers (e.g., Basic Plus, Core, CIIBS)

Annual budgets for IFS vary depending on assessed support needs (e.g., Level 1–4), with specific service caps based on waiver definitions.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Development
Timeline: 2–3 weeks

Phase: DDA Qualification & ProviderOne Enrollment
Timeline: 1–2 months

Phase: Staff Onboarding & Training
Timeline: 2–4 weeks

Phase: Participant Referrals & Service Start
Timeline: Begins after PCSP authorization and IFS budget allocation

9. CONTACT INFORMATION

Developmental Disabilities Administration (DDA)
Website: https://www.dshs.wa.gov/dda

Health Care Authority (HCA)
Website: https://www.hca.wa.gov

ProviderOne Medicaid Enrollment Portal
Website: https://www.waproviderone.org

County Developmental Disabilities Programs Directory
Website: https://www.dshs.wa.gov/dda/county-best-practices

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON IFS PROVIDER
WCG empowers local providers to establish IFS-compliant programs with streamlined enrollment, strong documentation, and client-focused service delivery.

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Scope of Work:

DDA and Medicaid provider enrollment support

IFS Policy & Procedure Manual development

Service authorization forms and billing templates

Staff onboarding materials and compliance trackers

PCSP alignment tools and client intake forms

HIPAA, emergency response, and grievance policy setup

CASE MANAGEMENT SERVICES PROVIDER IN WASHINGTON
COORDINATING INDIVIDUALIZED SERVICES, ADVOCACY, AND SUPPORT TO PROMOTE HEALTH, SAFETY, AND COMMUNITY LIVING

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Case Management Services in Washington provide ongoing coordination, planning, and monitoring of services for individuals with disabilities, chronic conditions, or complex needs. Case managers act as the central point of contact for Medicaid waiver participants, Apple Health members, and long-term services and supports (LTSS) recipients, ensuring that individuals receive appropriate care and achieve their person-centered goals.

Case Management is delivered under Home and Community-Based Services (HCBS) waivers administered by the Developmental Disabilities Administration (DDA) and Aging and Long-Term Support Administration (ALTSA), and reimbursed by Medicaid through the Health Care Authority (HCA).

1. GOVERNING AGENCIES

Agency: Developmental Disabilities Administration (DDA)
Role: Oversees case management for individuals enrolled in DDA HCBS waivers (e.g., Basic Plus, Core, IFS).

Agency: Aging and Long-Term Support Administration (ALTSA)
Role: Administers case management for elderly or physically disabled adults in COPES, MAC, or CFC programs.

Agency: Health Care Authority (HCA)
Role: Administers Apple Health Medicaid and manages reimbursement via ProviderOne.

2. CASE MANAGEMENT SERVICES OVERVIEW

Core responsibilities include:

Initial and ongoing assessments to determine support needs

Development and monitoring of the Person-Centered Service Plan (PCSP)

Service coordination and referrals to healthcare, behavioral health, housing, and waiver supports

Advocacy on behalf of the individual and family

Crisis planning and risk management

Quality assurance and follow-up

Documentation of services and outcomes

Services must align with WAC 388-825, WAC 388-106, or DDA policy depending on the waiver.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Washington Secretary of State

Obtain an EIN and Type 2 NPI

Apply with DDA or ALTSA as a Qualified Case Management Agency

Enroll with ProviderOne to bill Medicaid

Hire or contract qualified case managers with required credentials

Submit a Policy & Procedure Manual for Case Management Services

Complete staff training in person-centered planning, HIPAA, and abuse prevention

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI
Step 2: Submit Case Management agency application to DDA or ALTSA
Step 3: Enroll in ProviderOne with appropriate taxonomy code
Step 4: Develop and submit a compliant Case Management P&P Manual
Step 5: Ensure staff meet education and experience requirements
Step 6: Begin receiving referrals from state case managers upon approval

5. REQUIRED DOCUMENTATION

Medicaid enrollment confirmation via ProviderOne

Case Management contract with DDA or ALTSA

Policy & Procedure Manual, including:

Intake and service authorization workflows

PCSP development and review process

Crisis response and reporting

Confidentiality, HIPAA, and data protection

Cultural competency and equitable service delivery

Monthly monitoring logs and contact documentation

Staff credentials, supervision, and continuing education logs

Client rights and grievance procedures

6. STAFFING REQUIREMENTS

Role: Case Manager / Service Coordinator
Requirements:

Bachelor’s degree in social work, human services, or related field

At least one year of experience working with individuals with disabilities or aging adults

Knowledge of Medicaid, HCBS, and person-centered practices

Completion of DDA or ALTSA case manager training modules

Role: Program Supervisor / Lead Case Manager
Responsibilities: Reviews documentation, ensures compliance, and provides oversight

All staff must complete:

HIPAA and client rights training

Abuse prevention and mandatory reporting

Person-Centered Service Plan development training

Annual performance and documentation reviews

7. MEDICAID PROGRAMS THAT INCLUDE CASE MANAGEMENT

Basic Plus, Core, and IFS Waivers (DDA) – Ongoing case management required

COPES and CFC (ALTSA) – Case management provided by care coordinators or contracted agencies

Medicaid Alternative Care (MAC) – Supports unpaid caregivers with coordination

Apple Health (MCOs) – Care coordination may be integrated into health plan services

8. TIMELINE TO LAUNCH

Phase: Business Formation & Credential Setup
Timeline: 2–4 weeks

Phase: DDA/ALTSA Application & ProviderOne Enrollment
Timeline: 1–2 months

Phase: Staff Hiring, P&P Manual Development, Training
Timeline: 30–60 days

Phase: Begin Receiving Referrals
Timeline: Upon agency approval and contract execution

9. CONTACT INFORMATION

Developmental Disabilities Administration (DDA)
Website: https://www.dshs.wa.gov/dda

Aging and Long-Term Support Administration (ALTSA)
Website: https://www.dshs.wa.gov/altsa

Health Care Authority (HCA)
Website: https://www.hca.wa.gov

ProviderOne Enrollment Portal
Website: https://www.waproviderone.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON CASE MANAGEMENT PROVIDER
WCG helps professionals and organizations launch Medicaid-eligible case management agencies, with full compliance support for HCBS waiver participation.

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Scope of Work:

Medicaid and DDA/ALTSA enrollment guidance

Case Management Policy & Procedure Manual tailored to Washington standards

PCSP templates and monthly contact tracking tools

Staff credentialing and training documentation

HIPAA, consent, and client rights forms

Referral, intake, and service coordination workflows

NON-MEDICAL TRANSPORTATION SERVICES PROVIDER IN WASHINGTON
FACILITATING ACCESS TO COMMUNITY, EMPLOYMENT, AND ESSENTIAL SERVICES THROUGH SAFE, RELIABLE TRANSPORTATION

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Non-Medical Transportation (NMT) Services in Washington support individuals with disabilities, older adults, and Medicaid waiver participants by providing rides to and from day programs, employment sites, medical appointments, and community activities. These services are critical for promoting independence, inclusion, and person-centered living.

NMT is a covered benefit under Home and Community-Based Services (HCBS) waivers such as Basic Plus, Core, and Individual and Family Services (IFS). Oversight is provided by the Developmental Disabilities Administration (DDA) and Aging and Long-Term Support Administration (ALTSA), with reimbursement through Apple Health Medicaid via the Health Care Authority (HCA).

1. GOVERNING AGENCIES

Agency: Developmental Disabilities Administration (DDA)
Role: Authorizes NMT for individuals with developmental disabilities as part of their Person-Centered Service Plan (PCSP).

Agency: Aging and Long-Term Support Administration (ALTSA)
Role: Oversees NMT for eligible elderly or physically disabled adults.

Agency: Health Care Authority (HCA)
Role: Reimburses transportation services through Medicaid’s ProviderOne system.

2. NON-MEDICAL TRANSPORTATION SERVICES OVERVIEW

NMT providers transport eligible individuals to approved destinations outlined in the participant’s PCSP. This may include:

Day programs and community centers

Work or volunteer placements

Adult day health and habilitation services

Grocery shopping or banking (if in PCSP)

Recreational or social events (goal-oriented)

Note: NMT differs from Non-Emergency Medical Transportation (NEMT), which is provided by brokers (e.g., MTM, LogistiCare) for medical appointments.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Washington Secretary of State

Obtain an EIN and Type 2 NPI

Apply to become a Medicaid provider through ProviderOne

Contract with DDA or ALTSA as an NMT provider

Submit proof of automobile liability insurance and vehicle registration

Obtain driver background checks and driving records

Create a Transportation Services Policy & Procedure Manual

Commercial driver’s license (CDL) is not required unless transporting 16+ passengers.

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business, secure EIN and NPI
Step 2: Enroll in ProviderOne with appropriate taxonomy (e.g., transportation or waiver services)
Step 3: Contract with DDA or ALTSA as an NMT provider
Step 4: Submit required vehicle and driver documentation
Step 5: Finalize safety, HIPAA, and service protocols
Step 6: Begin receiving referrals upon approval

5. REQUIRED DOCUMENTATION

ProviderOne enrollment confirmation

Medicaid contract with DDA or ALTSA

Vehicle registration and inspection documentation

Driver license and driving abstract (updated annually)

Policy & Procedure Manual including:

Vehicle maintenance logs

Rider eligibility and pick-up procedures

Emergency protocols and incident reporting

HIPAA compliance and confidentiality procedures

Staff training and orientation checklist

Daily transportation logs and billing forms

Grievance and no-show policies

6. STAFFING REQUIREMENTS

Role: Driver / Transportation Assistant
Requirements:

Valid Washington driver’s license

Clean driving record and background check

Training in passenger safety, disability awareness, and emergency response

Role: Dispatcher / Scheduler (optional)
Responsibilities: Coordinates routes, maintains logs, and ensures efficiency

All staff must complete:

CPR/First Aid certification

HIPAA and client confidentiality training

Mandatory reporter training

Annual vehicle and safety training updates

7. MEDICAID PROGRAMS THAT COVER TRANSPORTATION

Transportation services are authorized under:

Basic Plus, Core, and IFS Waivers (DDA) – For travel to waiver-approved services

Community First Choice (CFC) – May cover transportation if identified in PCSP

COPES Waiver (ALTSA) – For essential trips for elderly adults

Apple Health (HCA) – Reimbursement limited to non-medical transit under HCBS

All rides must be pre-approved and linked to participant goals or care plans.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Compliance Documentation
Timeline: 2–4 weeks

Phase: ProviderOne Enrollment & Contracting with DDA/ALTSA
Timeline: 1–2 months

Phase: Vehicle Prep, Staff Onboarding, and Policy Setup
Timeline: 2–4 weeks

Phase: Service Delivery
Timeline: Begins upon contract execution and service authorization

9. CONTACT INFORMATION

Developmental Disabilities Administration (DDA)
Website: https://www.dshs.wa.gov/dda

Aging and Long-Term Support Administration (ALTSA)
Website: https://www.dshs.wa.gov/altsa

Health Care Authority (HCA)
Website: https://www.hca.wa.gov

ProviderOne Enrollment Portal
Website: https://www.waproviderone.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON NMT PROVIDER
WCG supports entrepreneurs and provider agencies in launching transportation services that meet all DDA, ALTSA, and Medicaid requirements.

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Scope of Work:

ProviderOne enrollment and waiver contracting assistance

Transportation Policy & Procedure Manual

Vehicle and driver documentation templates

HIPAA and incident response policies

Trip logs, client consent, and billing forms

Staff training and onboarding checklist

HOME HEALTH CARE SERVICES PROVIDER IN WASHINGTON
DELIVERING SKILLED NURSING, THERAPY, AND HEALTH MONITORING TO INDIVIDUALS IN THE COMFORT OF THEIR HOMES

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Home Health Care Services in Washington provide intermittent, medically necessary services to individuals who are recovering from illness, managing chronic health conditions, or requiring short-term support after a hospital stay. These services help clients remain independent, avoid unnecessary institutionalization, and safely heal at home under professional supervision.

Home Health Care is covered under Apple Health (Medicaid) and Medicare when authorized by a physician. Services may also be available to participants of Home and Community-Based Services (HCBS) Waivers, including the Community Options Program Entry System (COPES) and waivers administered by the Developmental Disabilities Administration (DDA).

1. GOVERNING AGENCIES

Agency: Washington State Department of Health (DOH)
Role: Licenses and regulates Home Health Agencies (HHAs) and ensures compliance with federal and state healthcare standards.

Agency: Health Care Authority (HCA)
Role: Administers Apple Health (Medicaid) and oversees Medicaid reimbursement for home health services.

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Governs federal participation, Conditions of Participation (CoPs), and Medicare certification for HHAs.

2. HOME HEALTH CARE SERVICES OVERVIEW

Home Health Services must be ordered by a physician and delivered under a Plan of Care.

Covered services may include:

Skilled Nursing Care – Medication administration, wound care, catheter care, IV therapy

Home Health Aide Services – Assistance with personal care under RN supervision

Physical Therapy (PT) – Strength, mobility, and recovery support

Occupational Therapy (OT) – Daily living skills training and adaptation

Speech-Language Pathology (SLP) – Communication and swallowing therapy

Medical Social Work – Crisis intervention, discharge planning, and counseling

Health Education – For patients and family caregivers

Coordination with Primary Care Providers

Home Health Services are intermittent, not 24/7 care, and require clinical documentation and medical necessity.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Washington Secretary of State

Obtain EIN and Type 2 NPI

Apply for a Home Health Agency license through the DOH Facility Licensing and Certification Division

If pursuing Medicare reimbursement: Apply for CMS Medicare Certification

Enroll as a Medicaid provider via the ProviderOne Portal

Maintain clinical liability, malpractice, and worker’s compensation insurance

Create a Home Health Policy & Procedure Manual in accordance with CMS Conditions of Participation and DOH rules

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register your business, obtain EIN and NPI
Step 2: Submit Home Health Agency license application to DOH
Step 3: Apply for Medicare Certification (if applicable)
Step 4: Enroll in ProviderOne as a Medicaid Home Health provider
Step 5: Complete staff credentialing and background checks
Step 6: Undergo pre-license and post-license inspections
Step 7: Begin services following physician orders and Plan of Care approval

5. REQUIRED DOCUMENTATION

EIN, NPI, and Articles of Incorporation

DOH Home Health Agency license

ProviderOne enrollment confirmation

CMS Certification (if billing Medicare)

Home Health Services Policy & Procedure Manual, including:

Scope of skilled nursing, therapy, and aide services

Plan of Care templates and physician communication logs

Infection control, emergency, and universal precautions policies

Medication administration and clinical charting protocols

Staff orientation, credentialing, and continuing education policies

Patient rights, HIPAA compliance, and grievance procedures

Billing, time tracking, and shift documentation tools

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements: WA licensure, CPR-certified, responsible for clinical assessments and POC implementation

Role: Licensed Practical Nurse (LPN)
Requirements: WA licensure, supervised by RN, may provide skilled nursing care

Role: Certified Home Health Aide (CHHA)
Requirements: Trained in ADLs, works under RN supervision, must meet DOH standards

Role: Therapists (PT, OT, SLP)
Requirements: Licensed by DOH, responsible for treatment plans and service delivery

Role: Medical Social Worker (MSW) (optional)
Requirements: Licensed in social work, supports emotional and planning needs

All staff must complete:

HIPAA and client rights training

Abuse prevention and emergency preparedness

Infection control and safety procedures

Annual competency assessments and continuing education

7. MEDICAID PROGRAMS THAT COVER HOME HEALTH

Home Health is available under:

Apple Health (State Plan Medicaid) – For short-term skilled home care with physician orders

Community Options Program Entry System (COPES) – Home health authorized within the waiver service package

DDA Waivers (Basic Plus, Core) – Skilled care authorized through PCSP

Medicare – If dual-eligible and medically qualified for post-acute care

8. TIMELINE TO LAUNCH

Phase: Business Setup & Licensing Application
Timeline: 1–2 months

Phase: CMS Certification (if applicable)
Timeline: 2–4 months

Phase: ProviderOne Enrollment & Staff Readiness
Timeline: 30–60 days

Phase: Launch of Services
Timeline: Begins upon license approval, staff onboarding, and physician Plan of Care authorization

9. CONTACT INFORMATION

Washington Department of Health (DOH) – Facility Licensing
Website: https://www.doh.wa.gov

Washington Health Care Authority (HCA)
Website: https://www.hca.wa.gov

Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov

ProviderOne Enrollment Portal
Website: https://www.waproviderone.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON HOME HEALTH PROVIDER
WCG supports new and existing agencies in launching Medicare/Medicaid-compliant home health services in Washington.

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Scope of Work:

DOH and ProviderOne enrollment assistance

CMS-compliant Home Health Policy & Procedure Manual

Templates for Plan of Care, shift notes, and medication logs

Staff credentialing packets and continuing education tracking

Infection control, emergency response, and incident reporting policies

Billing documentation and clinical workflow setup

MEAL & NUTRITION SERVICES PROVIDER IN WASHINGTON
PROMOTING HEALTH, INDEPENDENCE, AND WELL-BEING THROUGH NUTRITIONALLY BALANCED MEALS AND DIETARY SUPPORT

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Meal and Nutrition Services in Washington provide nutritious, medically appropriate meals and dietary education to individuals who are unable to prepare meals for themselves due to age, disability, or health conditions. These services play a key role in preventing malnutrition, managing chronic conditions, and enabling people to safely remain in their homes.

Meal support may be delivered in-home, through home-delivered meal programs, or in congregate settings such as adult day centers. These services are available through Medicaid Home and Community-Based Services (HCBS) waivers, including Community First Choice (CFC), Basic Plus, and Core Waivers, and through Area Agencies on Aging (AAA) under the Older Americans Act (OAA).

1. GOVERNING AGENCIES

Agency: Health Care Authority (HCA)
Role: Oversees Medicaid reimbursement under Apple Health and authorizes services through the ProviderOne portal.

Agency: Department of Social and Health Services (DSHS) – Aging and Long-Term Support Administration (ALTSA)
Role: Manages meal delivery and nutrition education services for older adults and HCBS waiver recipients.

Agency: Developmental Disabilities Administration (DDA)
Role: Authorizes meal services for waiver participants with intellectual and developmental disabilities.

Agency: Area Agencies on Aging (AAAs)
Role: Coordinate congregate and home-delivered meals under the Older Americans Act.

2. MEAL & NUTRITION SERVICES OVERVIEW

Meal & Nutrition Services can be delivered through:

Home-delivered meals (e.g., daily or weekly deliveries of prepared meals)

Congregate meals (e.g., community meal programs in adult day health settings)

Medical Nutrition Therapy (MNT) (e.g., individualized plans developed by registered dietitians)

Nutrition education and counseling for clients and caregivers

Grocery shopping support or meal prep assistance (when included in waiver plan)

Meal types may include:

Standard diets (nutritionally balanced)

Therapeutic diets (low sodium, diabetic, renal-friendly, etc.)

Texture-modified diets (pureed, soft foods)

Meals must meet state nutrition standards and be documented in the participant’s Person-Centered Service Plan (PCSP).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Washington Secretary of State

Obtain an EIN and Type 2 NPI

Enroll as a Medicaid provider via the ProviderOne Portal

Obtain applicable food service permits from your local health district

Hire or contract a Registered Dietitian (RD) for menu oversight and nutrition education

Develop a Meal & Nutrition Services Policy & Procedure Manual

If delivering meals: Establish sanitation, packaging, and transportation procedures

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI
Step 2: Apply for health permits and secure a commercial kitchen (if needed)
Step 3: Enroll as a Medicaid provider via ProviderOne under appropriate taxonomy
Step 4: Develop policies and hire qualified staff (including RD oversight)
Step 5: Connect with DDA or AAA case managers for referrals
Step 6: Begin services upon service authorization in the PCSP

5. REQUIRED DOCUMENTATION

Food establishment permit and sanitation inspection certificates

ProviderOne enrollment confirmation

Policy & Procedure Manual including:

Menu development and RD review logs

Meal packaging, delivery, and storage procedures

Food safety, temperature control, and allergy protocols

Client dietary assessments and tracking

Emergency meal backup plans

Staff training, HIPAA, and consent documentation

Templates for delivery logs, nutrition education, and grievance forms

6. STAFFING REQUIREMENTS

Role: Registered Dietitian (RD)
Requirements: WA state license; oversees dietary planning, client education, and menu review

Role: Food Service Coordinator / Chef
Responsibilities: Prepares meals based on dietary requirements, maintains cleanliness and food safety

Role: Delivery Driver / Program Assistant
Responsibilities: Delivers meals, records delivery logs, follows safety protocols

All staff must complete:

Food handler's certification

HIPAA and client confidentiality training

Elder abuse and mandatory reporting training

Emergency response protocols

Infection control and sanitation procedures

7. MEDICAID PROGRAMS THAT COVER MEAL SERVICES

Meal services may be reimbursable through:

Community First Choice (CFC) – For individuals needing help with nutrition to remain independent

Basic Plus and Core Waivers (DDA) – Meals included when prescribed as a support

COPES Waiver (ALTSA) – For older adults needing home-delivered meals

Older Americans Act (via AAAs) – Congregate and home-delivered meals (not means-tested but age-based)

Meal services must be authorized by a case manager and linked to the participant’s health and safety.

8. TIMELINE TO LAUNCH

Phase: Business Setup & Licensing
Timeline: 2–4 weeks

Phase: Health Permits & Kitchen Compliance
Timeline: 3–6 weeks

Phase: ProviderOne Enrollment & Policy Finalization
Timeline: 30–60 days

Phase: Referrals & Service Delivery Start
Timeline: Begins upon authorization in PCSP and readiness inspection (if needed)

9. CONTACT INFORMATION

Washington State Department of Health – Food Safety
Website: https://www.doh.wa.gov

Washington Health Care Authority (HCA)
Website: https://www.hca.wa.gov

Department of Social and Health Services (DSHS)
Website: https://www.dshs.wa.gov

ProviderOne Portal
Website: https://www.waproviderone.org

Washington Area Agencies on Aging (AAA Directory)
Website: https://www.agingwashington.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON MEAL SERVICES PROVIDER
WCG helps nutrition-focused businesses, chefs, and caregiving teams launch meal delivery programs that meet Medicaid and AAA standards

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Scope of Work:

Medicaid and AAA enrollment support

Food safety and RD-approved menu templates

Policy manual with delivery, sanitation, and emergency protocols

Staff onboarding and training documentation

Meal tracking logs, consent forms, and dietary plan tools

Compliance templates for food allergies, complaints, and quality reviews