Washington Behavioral Health & Substance Use Licensing Guide

Licensing agency

Department of Health (DOH)Licenses and certifies behavioral health agencies (BHAs)

Main license

BHA license with one or more certificationsChapter 246-341 WAC; renewed every year

Application fee

$2,250 for a new agencyPlus per-bed or outpatient service-hour fees

Opioid treatment

OTP certification on the BHA licensePlus Pharmacy Commission, SAMHSA and DEA approval

Accreditation

Deemed status for CARF, Joint Commission and COA agenciesReplaces routine DOH inspections and roughly halves service fees

Licensing or accrediting a program here? Book a free consultation or call 561-396-0813.

Who licenses behavioral health providers in Washington?

The Department of Health. DOH licenses inpatient and outpatient behavioral health agencies and certifies them for mental health, substance use disorder and problem gambling services. House Bill 1388 (2018) moved this work from the Department of Social and Health Services to DOH.¹ DOH also licenses residential treatment facilities (RTFs) under a separate chapter.¹⁷

The Health Care Authority (HCA) runs Apple Health, the state Medicaid program. Apple Health managed care organizations (MCOs) cover all levels of behavioral health care except crisis services. Regional behavioral health administrative services organizations (BH-ASOs) handle crisis services and, within available funds, care for people without Apple Health.¹⁰ HCA also houses the State Opioid Treatment Authority (SOTA).¹⁶

BHA certifications

Every BHA holds at least one of 17 certifications, which decide the services it may offer:³

• Outpatient and community: outpatient intervention, assessment and treatment; information and assistance; support services; clubhouse; peer respite; problem gambling; applied behavior analysis.
• Crisis: outpatient crisis, 23-hour crisis relief centers, designated crisis responders and crisis stabilization units.
• Residential and inpatient: voluntary and involuntary residential or inpatient treatment, intensive behavioral health treatment, withdrawal management and competency restoration.
• Opioid treatment program (OTP).

One license can cover several buildings on a single integrated campus under one governing authority. Other locations are licensed as branch sites.⁴

Law and rules

RCW 71.24.037 requires DOH to license or certify agencies that pay the fees and show they can meet the standards. A license lasts one calendar year and lists the services the agency may provide, and the statute requires DOH to deem accredited agencies as meeting state standards.² The detailed standards sit in chapter 246-341 WAC, rewritten in a rule that took effect May 1, 2023.²¹ RTFs are licensed under chapter 71.12 RCW and chapter 246-337 WAC.¹⁷ OTPs follow RCW 71.24.590, WAC 246-341-1000 and 42 CFR Part 8.^{11, 12}

How to apply for a BHA license

1. Choose certifications and a siteDecide which certifications and services you will offer. The site cannot be a personal residence and must meet ADA, building and safety requirements.⁴
2. Write your policiesPrepare policies and procedures that address chapter 246-341 WAC. DOH offers a policy and procedure review tool to check them.^{7, 8}
3. Gather documentsA copy of your Washington master business license, plus a background check and disclosure statement for the administrator dated within three months of applying.^{4, 7}
4. Submit the applicationFile the BHA licensing and certification application with a cover letter and the fees, online through DOH's HELMS system or on the paper form.^{1, 7, 8}
5. Review and on-site visitDOH reviews applications within a few days of receipt and flags missing items. It will not issue the license until it approves your policies, and it inspects every new agency. While your status shows as pending, do not operate.^{7, 4, 9}

Renewals and changes: a license runs up to 12 months, and the renewal and full fee must reach DOH before it expires. Adding a certification needs an application before services start; adding a service within an existing certification needs notice within 30 days. A change of ownership, including a new owner of 5% or more, needs a new initial application and license before services continue.⁴

Licensing fees

Fees go in with each initial or renewal application. Each year you report your accreditation status, licensed beds and outpatient service hours on a DOH form; new agencies project their first 12 months.⁶ The current BHA and RTF fees took effect July 15, 2025.^{6, 18} RTFs also pay a late fee of $33 per bed, up to $660, and $3,250 for a follow-up or complaint-driven survey.¹⁸

How accreditation counts in Washington

Deemed status: DOH deems an agency to meet state standards when it is accredited by a national body that has a current agreement with DOH. DOH names The Joint Commission, the Council on Accreditation and CARF International.^{5, 9} DOH has a separate deeming application.⁸

Survey waivers: deemed agencies are reviewed by their accreditor instead of receiving routine DOH inspections.⁹ A new main site, or a new type of service, still needs proof of accreditation and a DOH initial on-site review. A new branch offering services already deemed at the main site needs only proof of accreditation. Deemed agencies must send DOH their accreditation reports, and deeming cannot waive a statute.⁵

Fee breaks: deemed agencies pay $125 instead of $250 per residential or inpatient bed and about half the outpatient service-hour fee.⁶

Medicaid: HCA's Apple Health billing guide defines a behavioral health agency by its DOH license. Psychiatric residential treatment facilities for people 21 and under are the exception that names an accreditor: they need The Joint Commission or a comparable body recognized by the state.¹⁰

Opioid treatment: federal rules require accreditation. SAMHSA's approved bodies are CARF International, Social Current (formerly COA), The Joint Commission, the National Commission on Correctional Health Care and the Washington State Department of Health itself.¹⁵

Getting accredited? See our CARF accreditation consultants and Joint Commission consultants, available nationwide.

Opioid treatment programs

• Extra application items: OTP applicants also submit communication with the county, city or tribe on land use and a community relations plan. Out-of-state operators send six years of accreditation and certification reviews. Approval from the Pharmacy Quality Assurance Commission, SAMHSA and DEA must come before licensure.⁴
• Siting: DOH consults county and city authorities and licenses only programs that comply with local land use rules. Local governments may require a conditional use permit only on the terms they apply to other essential public facilities and health care settings, and may not cap an OTP's capacity. DOH also weighs local need, nearby programs and transportation.¹¹
• Medication units: an OTP may add mobile or fixed-site medication units, with notice to DOH and its approval before services start.^{11, 4} HCA counted 16 mobile units and one fixed-site unit in December 2025.¹⁶
• Operations: WAC 246-341-1000 adopts 42 CFR Part 8 and requires use of the state central registry.¹²
• DOH accreditation: an OTP can ask for DOH accreditation in the cover letter of its BHA application. DOH surveys about six months after state licensure and SAMHSA provisional certification.¹³
• Federal steps: SAMHSA grants one-year provisional certification after state licensure and DEA registration, and the program must be accredited within that year.¹⁴

Other approvals you may need

• Residential treatment facility license: a 24-hour residential program cannot open until DOH issues an RTF license. You need construction review and State Patrol fire protection approval first. The license lasts one year; renew at least 30 days before it expires.¹⁷
• Recovery residences: Peer-run and monitored homes (levels 1 and 2) are housing, not treatment. HCA keeps a registry of homes that meet quality standards through the Washington Alliance of Quality Recovery Residences (WAQRR). Levels 3 and 4 are treatment levels that DOH licenses.¹⁹ Since January 1, 2023, licensed or certified providers may not refer clients to a recovery residence that is not on the registry.²⁰
• Tribal attestation: Indian health care providers may attest to meeting BHA standards instead of going through standard licensure.⁷

Recent changes

• January 31, 2025: OTP rules were aligned with the updated 42 CFR Part 8 and began allowing fixed-site medication units.^{12, 21}
• June 29, 2025: voluntary residential, inpatient and withdrawal management SUD programs must report discharges without consent, transfers and early departures to DOH within 30 days.²⁴
• July 15, 2025: BHA and RTF fees increased.^{6, 18}
• June 30, 2026: 23-hour crisis relief centers can be certified to serve minors aged 8 to 17.²³
• SB 5988 (chapter 73, Laws of 2026, effective June 11, 2026): gives DOH authority to charge OTPs for its accreditation services.²² DOH has opened rulemaking to set the fee.²¹
• Rules in progress: OTP cleanup with fixed-site medication unit and dispensing technology standards, a uniform enforcement and background check rule, and a full review of the RTF chapter that began September 11, 2026.²¹

Confirm these with DOH

• The OTP accreditation fee DOH sets under SB 5988, and when it starts.
• Whether DOH's current agreement with your accreditor covers each certification you want deemed.
• The deemed rate for inpatient mental health beds, which DOH's fee page and the rule list differently.
• How outpatient service-hour fees are billed at renewal for your agency.
• The outcome of open rulemakings on medication units, enforcement fines and the RTF chapter.
• For OTPs: local land use status and what DOH expects in the community relations plan.

Sources

1. Washington DOH, Behavioral health agencies (BHA). doh.wa.gov
2. Revised Code of Washington, RCW 71.24.037, Agency licensing. app.leg.wa.gov
3. Washington Administrative Code, WAC 246-341-0110, Available certifications. app.leg.wa.gov
4. Washington Administrative Code, WAC 246-341-0300, Licensure and certification. app.leg.wa.gov
5. Washington Administrative Code, WAC 246-341-0310, Deeming. app.leg.wa.gov
6. Washington Administrative Code, WAC 246-341-0365, Fee requirements. app.leg.wa.gov
7. Washington DOH, BHA license requirements. doh.wa.gov
8. Washington DOH, BHA applications and forms. doh.wa.gov
9. Washington DOH, BHA inspection process. doh.wa.gov
10. Washington HCA, Mental health services billing guide (July 2026). hca.wa.gov
11. Revised Code of Washington, RCW 71.24.590, Opioid treatment programs. app.leg.wa.gov
12. Washington Administrative Code, WAC 246-341-1000, Opioid treatment programs. app.leg.wa.gov
13. Washington DOH, Opioid treatment program accreditation. doh.wa.gov
14. SAMHSA, Become an opioid treatment program. samhsa.gov
15. SAMHSA, Approved accreditation bodies. samhsa.gov
16. Washington HCA, Opioid treatment programs fact sheet (December 2025). hca.wa.gov
17. Washington Administrative Code, WAC 246-337-010, RTF licensing. app.leg.wa.gov
18. Washington Administrative Code, WAC 246-337-990, RTF licensing fees. app.leg.wa.gov
19. Washington HCA, Recovery residences fact sheet (November 2025). hca.wa.gov
20. Revised Code of Washington, RCW 71.24.660, Referrals to recovery residences. app.leg.wa.gov
21. Washington DOH, BHA rules in progress. doh.wa.gov
22. Washington State Legislature, SB 5988 (2026), OTP accreditation fee authority. app.leg.wa.gov
23. Washington Administrative Code, WAC 246-341-0903, 23-hour crisis relief center services. app.leg.wa.gov
24. Washington Administrative Code, WAC 246-341-1108, Residential and inpatient SUD services. app.leg.wa.gov

This guide summarizes Washington statutes, rules and DOH and HCA pages as of the date above. It is general information, not legal advice. Requirements change; confirm with DOH before you apply.