Arkansas Home Health Regulations: Licensing, Survey, and Fees

To operate legally in Arkansas, a home health agency license is issued by the Division of Health Facility Services within the Arkansas Department of Health, and the Arkansas home health agency license requirements run in a set order: obtain a Permit of Approval from the Health Services Permit Agency, build out your office and staffing infrastructure, file a written application with the required fee, and pass an on-site initial survey before accepting patients. Any public or private organization that provides home health services for pay in a patient’s residence falls under this requirement.¹

“Home health services” is defined broadly. It covers nursing, physical therapy, occupational therapy, speech therapy, medical social services, home health aide services, and personal care delivered or coordinated at the patient’s residence.² “Residence” is also broad, reaching private homes as well as nursing or convalescent facilities where the patient lives.¹ If your organization provides any of those services for compensation, you need a license.

Which License Class You Need

Arkansas issues two classes. A Class A license is for an agency that is Medicare-certified at the time of application or is actively in the process of obtaining that certification from CMS.¹ Most new agencies pursuing Medicare billing apply for Class A and start the federal certification work in parallel.

Class B is a legacy classification. The applicant must show proof of the services it provided and the geographic territory it covered as of July 20, 1987, and must have requested a survey confirming that history.¹ In practice, Class B applies to grandfathered agencies that were operating before the current framework took effect and never pursued Medicare certification.

Get the Permit of Approval First

You cannot submit a license application until you have a Permit of Approval from the Health Services Permit Agency. The state rules are explicit on sequence: the POA comes before the license application.³ The POA is a threshold evaluation that screens proposed agencies before the state invests resources in a full licensure review.

ADH outlines the POA as a multi-step process that requires you to identify the specific type of home health agency you intend to operate.⁴ It runs on its own schedule. Having your license application drafted early will not compress that timeline.

What You Need in Place Before You Apply

While your POA is pending, build the infrastructure the state will evaluate at licensure. The desk review and the on-site inspection both look for these elements.

A fully operational physical office in Arkansas where patient records are maintained and services are directed.
A qualified administrator who is an agency employee and is either a physician, a registered nurse, or someone with at least one year of supervisory or administrative experience in home health care or a related health program.³
Written policy and procedure manuals covering organizational structure, patient rights, quality assurance, and infection control, among other operational areas.
Workers’ compensation insurance. Arkansas law generally requires coverage for employers with three or more employees, with some exceptions for smaller employers.⁵
Full ownership disclosure, including any subcontracting businesses in which an owner holds at least a five percent interest.

Application, Fees, and the Initial Survey

Once you hold the POA, file a written application with the Division of Health Facility Services. The annual license fee is $1,000 for the main agency and $100 for each subunit operating in a different geographic area.⁶ A subunit is a branch that serves patients in a territory separate from your main office.¹

ADH starts with a desk review of your ownership documents and policy manuals. If those pass, an on-site initial licensure survey follows. Inspectors verify that your physical office meets requirements, test whether your written policies translate into actual practice, and interview administrative staff. Agencies that fall short get an opportunity to correct deficiencies, with a follow-up visit or mail review to confirm the fixes.³

Health Facility Services sits at 5800 W. 10th St., Suite 400, Little Rock, AR 72204. Phone 501-661-2201, fax 501-661-2165, email adh.hfs@arkansas.gov.

Background Checks

Every operator, every applicant for employment, and every employee of a home health agency must undergo a criminal history records check, and the agency must keep evidence that each check was done.⁷ The scope of the check depends on residency. If you can verify that an applicant has lived continuously in Arkansas for the past five years, a state criminal history check plus a registry check is enough. If not, fingerprints go in for a national criminal history check as well.⁸

Operators have a separate obligation. When applying for a license, the operator must submit fingerprints to the Arkansas State Police for both state and national criminal history checks, and must repeat that process at least once every five years.

Operating Standards the Survey Will Test

Home Health Aide Training

Aides must complete a training program of at least 75 hours that combines classroom instruction and supervised hands-on practice. Federal regulations require a minimum of 16 hours of classroom training before at least 16 hours of supervised practical training where the aide demonstrates skills under the direct supervision of a registered nurse.⁹ The Arkansas rules incorporate that federal floor. CMS also expects agencies to evaluate aide competency at hire, annually, and before assigning new tasks.

Plan of Care

Every patient must have a written plan of care describing the services to be provided, their frequency, and their duration. The plan of care and any verbal orders must be signed by the ordering physician, podiatrist, or licensed practitioner within 30 days.² Signature lapses are among the easier citations to accumulate, and a simple tracking system prevents most of them.

Patient Rights

Agencies must uphold patient rights, including the right to be informed about care, to participate in care planning, and to be free from abuse, neglect, and misappropriation of property. Protections extend to verbal, mental, sexual, and physical abuse. Surveyors evaluate these obligations as enforceable, not aspirational.

Record Retention

Keep patient records for at least five years after discharge. Records for minors must be kept for at least three years after the patient reaches 18. These are minimums; agencies that participate in Medicare or Medicaid may have additional federal retention obligations.

Mandatory Abuse Reporting

Home health workers are mandated reporters under Arkansas law. Suspected or observed abuse, neglect, or exploitation of an endangered or impaired adult must be reported to the Adult Maltreatment Hotline at 1-800-482-8049.¹⁰ The duty attaches to each worker individually, not just to the agency, and exists regardless of whether a supervisor has been notified. The reporting rules are set out in Ark. Code Ann. § 12-12-1708.

If You Also Want to Bill Medicare

A Class A license permits you to pursue Medicare certification, but the federal program imposes its own obligations that run parallel to and independently of your state license. Those include OASIS data collection in patient assessments under the current OASIS-E2 version that took effect April 1, 2026,¹¹ a CMS emergency preparedness program with staff training and periodic exercises,¹² and, for Medicaid-funded services, Electronic Visit Verification under Section 12006 of the 21st Century Cures Act.¹³ Arkansas implemented EVV for self-directed programs through the Department of Human Services beginning in April 2021.¹⁴ None of these federal pieces substitute for the state license; they stack on top of it.

Keeping the License

After initial licensure, the Arkansas Department of Health conducts inspections at least every three years to verify ongoing compliance.³ These are not announced far in advance. The survey covers the same ground as the initial inspection: staffing credentials, patient care documentation, policy adherence, and facility standards.

You must also notify Health Facility Services when certain things change, including a change of ownership, a change in the administrator, or a change in the agency’s physical location. Reporting these is a licensing condition, not a courtesy, and gaps show up at the next survey.

For a sale or change of ownership, the new owner must obtain a Change of Ownership Packet from the Health Facility Services section, which can be requested by mail, email, or fax.¹⁵ Make clear whether you need a new-provider packet or a change-of-ownership packet; the requirements differ. Notifying ADH early in any ownership transition avoids a lapse in licensure that could interrupt patient services.³

What Happens If You Operate Without a License

Operating a home health agency in Arkansas without a license carries criminal penalties, and each day a person provides home health services after a first conviction counts as a separate subsequent offense.¹⁶ An agency that keeps operating after being cited is stacking offenses, not just fines.

The Division of Health Facility Services can also deny, suspend, or revoke a license for violating the licensing statute or its rules, permitting unlawful acts in connection with the agency’s operation, or engaging in practices that endanger the health or safety of patients and employees. Agencies facing these actions have the right to an administrative hearing.

1
Justia. Arkansas Code 20-10-801 – Definitions
2
Arkansas Department of Health. Rules for Home Health Agencies in Arkansas
3
Arkansas Department of Health. Rules for Home Health Agencies in Arkansas
4
Arkansas Department of Health. Permit of Approval Process
5
Arkansas Department of Labor and Licensing. Basic Facts
6
Justia. Arkansas Code 20-10-812 – Fees
7
Arkansas Department of Health. Rules and Regulations for Conducting Criminal History Records Checks for Home Health, Hospice and Private Care Agencies in Arkansas
8
Justia. Arkansas Code 20-33-213 – Criminal History and Registry Records Checks
9
eCFR. 42 CFR 484.80 – Condition of Participation: Home Health Aide Services
10
Arkansas Department of Human Services. Mandated Reporters of Adult Maltreatment
11
Centers for Medicare & Medicaid Services. Outcome and Assessment Information Set OASIS-E2 Manual
12
Centers for Medicare & Medicaid Services. Understanding the Emergency Preparedness Final Rule
13
Medicaid.gov. EVV Requirements in the 21st Century Cures Act
14
Arkansas Department of Human Services. Electronic Visit Verification (EVV)
15
Arkansas Department of Health. Applications for New Providers and Change of Ownership
16
Justia. Arkansas Code 20-10-803 – Penalties