License Fee Increases
Frequently Asked Questions (FAQs)
The legislature authorizes the Department of Health to increase fees for licensed health professions and entities. In 2010 and 2011 the legislature authorized fee increases. It also passed a
bill requiring midwives and marriage and family therapists to pay the
HEAL-WA online access fee through the University of Washington. The department sets fees in rules through a formal rulemaking process. The rule process starts when the legislature and Governor approve the department’s budget.
Which professions received fee increases in 2010?
If my profession had a fee increase in 2010, when do I have to start paying the new fees?
Which professions are receiving fee increases in 2011?
If my profession will have a fee increase in 2011, when do I have to start paying the new fees?
How much is my fee increasing?
Why does the department raise fees?
How does the department determine fees?
What does my fee pay for?
Why are fees increasing in 2011?
Why do fees increase for some professions, but not for others?
Shouldn’t more licensees in a profession mean lower fees?
I make less money than another profession. Why are my fees higher?
What are discipline costs and why do I have to pay them?
Why don’t people pay for their own discipline costs instead of making innocent people pay?
Why are the renewals fees so high? It doesn’t cost that much to print a card.
Why is my fee higher in Washington than another state?
What is the HEAL-WA fee? Why do I have to pay it; or Why doesn’t everyone have to pay it?
Why is the time for public comment so short?
What happens if fees aren’t raised?
Can I pay my fees online?
Can I pay part of the fee now and part later?
Is there a grace period to pay my fee?
Where can I get more information?
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Which professions received fee increases in 2010?
- Acupuncture (East Asian Medicine Practitioner
- Advanced registered nurse practitioner
- Dentist
- Dental assistant
- Denturist
- Licensed practical nurse
- Mental health counselor
- Midwife
- Nurse technologist
- Nursing Assistant
- Optometrist
- Radiologic technologist
- Recreational therapy
- Registered nurse
- Respiratory care
- Social Worker
- X-ray technician
If my profession had a fee increase in 2010, when do I have to start paying the new fees?
The fee increases were effective October 15, 2010. This means that if your profession received a fee increase in 2010, the new fee is effective for healthcare providers with a date of birth on or after October 15.
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Which professions are receiving fee increases in 2011?
- Chiropractor
- Chiropractic x-ray technician
- Dietitian and Nutritionist
- Healthcare assistant
- Hearing and Speech (Includes audiologist, speech language pathologist, and hearing instrument fitter/dispenser. Does not include speech language pathology assistant.)
- Hypnotherapist
- Marriage and family therapist (HEAL-WA only)
- Midwife (HEAL-WA only)
- Nursing home administrator
- Occupational therapist
- Occupational therapy assistant
- Orthotist and Prosthetist
- Pharmacy firms
- Pharmacist
- Pharmacy intern
- Pharmacy technician
- Psychologist
- Surgical technologist
- Veterinarian
- Veterinary medical clerk
- Veterinary technician
- Humane society/animal control agency (entity)
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If my profession will have a fee increase in 2011, when do I have to start paying the new fees?
The 2011 fee increases were adopted and filed on October 4, 2011. The
increases are effective December 1, 2011 for the professions listed above. This means that
applications received on or after December 1, 2011, must include the new fee and practitioners with a date of birth on or after
December 1 must pay the new renewal fee. The department generally mails courtesy renewal notices six to eight weeks before the expiration date; but the department may delay this until it formally adopts the new fees.
New fees are required when the rules are adopted. The renewal notices will indicate the new fee amount.
How much is my fee increasing?
To view the adopted fees for your profession, please refer to the fees by profession table for the year your fees increased, either
2010 or
2011. Marriage and family therapists and midwives should view the
HEAL-WA fee table.
Why does the department raise fees?
State law requires that each profession is self-supporting. Fees must cover the costs to administer and regulate the profession. The department must raise fees because the costs for the listed professions are projected to exceed the projected revenue received through the fees the profession’s licensees pay.
How does the department determine fees?
The department is mandated to ensure that each profession is self-supporting. The department annually analyzes the revenue and expenses for all professions, considering past, current, and future biennia to determine if a profession’s revenue is sufficient to administer the program.
The analysis indicated that the professions included in the proposed fee increases do not have sufficient funds to meet projected costs. The projected costs include inflationary impacts, costs to discipline practitioners, credentialing, and the ability to provide online licensing and renewals for practitioners. Please see the question on
online licensing for more information.
When a profession’s revenue and fund balance do not support current or projected expenses, the department must consider increasing the profession’s fees. The request to raise fees is submitted to the legislature.
What does my fee pay for?
Fees support the administration and regulation of the profession and include:
- Implementing standards for new professions or expanding scopes of practice the legislature sets during a legislative session.
- Disciplinary activities. Patient safety is the department’s number one priority. Allowing unsafe providers to practice hurts the people of the state as well as the public’s faith in the department and the profession. The data below is for the professions included in the proposed fee increases.
- From 7/1/09 through 12/31/10, the department received more than 10,288 new complaints against the practitioners for the professions included in the proposed fee increases.
- Work continues on more than 606 complaints from the prior biennium.
- From 7/1/09 through 12/31/10, the department completed 1,242 investigations and authorized an additional 1,231 investigations.
- During this same time period the disciplinary authority took 420 disciplinary actions. Of these, 20 practitioners lost their license because of summary actions.
- Positive “hits” for a history of criminal convictions may occur during the background check process. Of the 50,866 background checks completed on applicants in these professions, the department received 423 positive “hits.” These positive hits often result in investigative activities (incurring more costs) to obtain additional information.
- Some records are so personal that special protections apply before investigators can obtain the records. This can add significant time to an investigation.
- Administrative costs. This includes salaries and benefits, utilities, building rents, postage, board/commission/committee support (if applicable), and other costs.
- Inflation cont continues to increase impacting all of the costs for a profession.
- Customer service. Expectations from the public and licensees for additional services continue to increase.
- Requests for online renewal. The department received legislative approval to proceed with plans to implement online renewal capability for licensees.
- Increases in licensing activities require the department to add more resources to meet the increased demand for services by licensees and the public, and to meet the department’s performance measure targets. To meet expectations for service, staffing for credentialing and discipline increased by 14 percent during the 2007-2009 biennium.
- The customer call center has experienced a significant increase in the number of calls from providers and the public. In 2009, the call center received an average of 24,936 each month. In 2010 the monthly average increased to 30,704 calls.
- Over a one-year period, customer service front counter staff assisted 24,600 walk-in customers just for the professions included in the proposed fee increases.
- Public demand for information on health care practitioners continues to increase. During 7/1/09 through 12/31/10, for the professions included in the proposed fee increases, the department responded to more than 1,635 requests for public records and processed approximately 43,627 pages.
- Legislation may increase costs. Examples include:
- 2007 – The Blue Ribbon Commission bill (ESSB5930) amended
RCW 43.70.110 (3)(c) and added an annual fee to access resources through the University of Washington
HEAL-WA Web portal for 14 professions. In 2011 the legislature included two more professions to HEAL-WA, midwives and marriage and family therapists.
- 2008 –
4SHB1103 reinforced the need for safe providers and strengthened the background check process. National fingerprint-based federal criminal background checks are for out-of-state applicants or in-state applicants with a Washington criminal history.
- Changes in a profession’s scope of practice, or creating a new category of provider within a profession, impact the costs to administer the profession.
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Why are fees increasing in 2011?
There are four areas that are impacting the projected expenses for all professions. These include:
- Inflation
- Discipline of unsafe providers
- Credentialing
- Online licensing
The department analyzed projected revenue and expenses for all professions. It must determine if a profession’s resources (revenue) are sufficient to meet the increased expenses associated with the four items listed above. The professions proposed to receive fee increases do not have sufficient resources to pay for these additional projected costs.
In addition, the 2011 legislature passed
Substitute Senate Bill 5071 that requires two professions to pay a fee to access the HEAL-WA online Web portal through the University of Washington. These professions are midwives and marriage and family therapists.
Why do fees increase for some professions, but not for others?
The number of licensees in a profession and the cost to administer the profession affects the fees. A profession with a high number of licensees and low costs will likely have lower fees than a profession with a low number of licensees and high costs.
Discipline is frequently a determining factor when analyzing and projecting costs, but discipline is not the only factor that impacts fees. For some professions the discipline may be stable, or even had fewer complaints filed in the current biennium compared to previous biennia; but the profession’s expenses still exceed the revenue.
High discipline rates usually means higher expenses for a profession. But, even professions with low discipline rates can have high costs depending upon the complexity of cases. Some professions with low discipline rates also have a low number of licensees, resulting in fewer licensees to share the costs.
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Shouldn’t more licensees in a profession mean lower fees?
Generally, yes. While there are more practitioners to share the costs, there may also be more costs to share. Some professions receive more complaints, require more investigations, and have higher rates of disciplinary activity. Some professions receive fewer complaints; but the cases investigated may be more complex than another profession’s cases.
Discipline cases vary in complexity levels. More complex cases require more work, resulting in higher costs. Some professions have been experiencing lower than average applicant rates, resulting in lower than projected revenue.
I make less money than another profession. Why are my fees higher?
The department can only consider revenue and expense for each profession. The department does not have the option to consider income, insurance, or educational requirements for any profession. The department also cannot consider health profession licensing fees in other states.
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What are discipline costs and why do I have to pay them?
All licensees in a profession must share the costs of the profession. This includes discipline. The department has seen a dramatic increase in discipline activity in recent years for some professions. The following impacts discipline costs:
- Complaints received.
- Background checks completed on applicants. A positive state or national background check adds to the disciplinary workload.
- Investigations on complaints received or positive results from a background check.
- Court cases have added requirements for how we collect evidence and have raised the level of proof necessary to move forward with discipline.
- Frequency and complexity of disciplinary cases continue to rise.
- Impaired provider programs costs have increased. These programs work with practitioners to prevent or reduce impaired practice.
Why don’t people pay for their own discipline costs instead of making innocent people pay?
State law requires that all licensees in a profession share equally in the cost for the profession. This includes discipline. In general, the department can assess specific fines; but these fines do not recover all of the discipline costs. With the exception of one profession, the laws do not allow the department to assess discipline costs against just the individuals involved. Legislation in 2009 authorized the department to assess additional costs against practitioners for one profession; under specific requirements.
Why are the renewals fees so high? It doesn’t cost that much to print a card.
Renewal fees are one part of the overall revenue for a profession. All activities contribute to the costs for credentialing and renewal. Renewal costs include more than the work and costs to send out the renewal notices, and the work to process renewals. One activity associated with renewals is to verify practitioners complete required continuing education, if applicable. Another activity that occurs more frequently with existing practitioners is requests for information on a practitioner. The public wants to know if their practitioner is licensed and if the practitioner has any complaints.
Why is my fee higher in Washington than another state?
States regulate professions based on the laws and rules of the individual state. While there may be similarities, no two states do everything the same. Some professions are regulated by the state, not boards or commissions. Some states have boards and commissions that regulate multiple professions.
Some states require reimbursement of discipline costs if the practitioner receives a sanction. Others require additional fees for specific elements of a practice; i.e., requiring a fee to prescribe controlled substances in addition to the fee paid to the federal government for a Drug Enforcement Agency number (DEA number).
Washington State law requires all practitioners in a profession share equally in the costs. This includes initial licensure, renewal, discipline, investigations, and administrative costs.
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What is the HEAL-WA fee? Why do I have to pay it; or Why doesn’t everyone have to pay it?
The department is not increasing the HEAL-WA fee for any profession. State law requires 14 professions to pay a fee to access online healthcare resources through the University of Washington’s
HEAL-WA Web portal. These 14 professions include: physicians, physician assistants, osteopathic physicians, osteopathic physician assistants, naturopaths, podiatrists, chiropractors, psychologists, registered nurses, optometrists, mental health counselors, massage therapists, social workers, and acupuncturists.
State law does not allow licensees to opt in or out of the fee. Some licensees who hold licenses in multiple professions may have to pay the fee for each profession. State law also does not allow other professions to pay the fee and gain access to the resources.
The 2011 legislature passed
Substitute Senate Bill 5071 that adds two professions to HEAL-WA. These include midwives and marriage and family therapists. The department is in the rulemaking process to add the HEAL-WA fee to these two professions.
Why is the time for public comment so short?
Rulemaking requirements are in law (Chapter 34.05 RCW). This law provides for a specific length of time for the public to provide comments. The department follows the standard time period for public comments. This includes holding a public hearing. Rulemaking begins when the legislature approves the department’s budget. The 2011 legislature approved the fee increases as part of the total budget package at the end of the special session. The department’s budget package includes revenue estimates based on the implementation date for the approved fee increases. This implementation date must occur without delay to avoid the negative impacts to a profession’s funding.
What happens if fees aren’t raised?
Patient safety is threatened as many services might not occur in a timely manner:
- Investigating and resolving complaints about health care professionals may take longer.
- Providing the protection and level of service the public expects.
- Licensing, including conducting fingerprint-based federal background and other national databank checks, might become backlogged. This could result in significant delays in issuing new licenses and renewals.
- A growing backlog of disciplinary cases slows decisions. In some cases, incompetent or unethical health providers could continue to practice.
Can I pay my fees online?
Not yet, but the department is working on providing this feature for health care providers. It does accept payments made by Visa, MasterCard, or debit when paid in person at our office in Tumwater. In 2011 the legislature approved a budget request to upgrade the licensing system (known as ILRS – Integrated Licensing and Regulatory System) to add online licensing for health care providers.
Online licensing is a complex project because each profession has unique licensing and renewal requirements. As the first step in this project, the department is working with the ILRS vendor to implement upgrades to the core ILRS system. These upgrades will correct problems in system functions. This must occur to implement online licensing. In addition, the department must develop contracts through the Office of the State Treasurer to process credit card payments.
After the department implements upgrades, it will begin setting up online licensing system modules that must meet department business processes and rules. Initially it will select four professions as a pilot project for online renewals. The department decided to start with renewals for two primary reasons:
- Renewals are less complex than new applications.
- It processes more renewals than new applications so more healthcare providers will benefit as professions go online.
When the pilot project is complete and renewals are effectively processed for these four professions, the department will add the remaining professions to online renewals. When all professions are on board for online renewals, the department will begin implementation of online processes for new applications.
Can I pay part of the fee now and part later?
No. State law requires that practitioners must pay the renewal fee to renew the credential and does not provide for partial payments or installment payments.
Is there a grace period to pay my fee?
No. The total fee is due on or before the expiration date. If the fee is not paid, then a late penalty fee is assessed.
Where can I get more information?
You can find more information on a profession on:
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