How to start a hospice in Arkansas

Arkansas requires a Hospice license (in-home hospice; in-patient direct care hospice) from Arkansas Department of Health, Health Facility Services (Health Systems Licensing and Regulation) to operate a hospice. Fee: The rule requires a licensure fee (e.g., on change of ownership) but does not print the amount.

License required

Yes

License

Hospice license (in-home hospice; in-patient direct care hospice)

Issuing agency

Arkansas Department of Health, Health Facility Services (Health Systems Licensing and Regulation)

Fee

The rule requires a licensure fee (e.g., on change of ownership) but does not print the amount.

Renewal

Every year

Survey and inspection

Licensure is based on a Department operational and physical plant survey; Department representatives may inspect at any time.

Certificate of need

Required

Medicare certification

Medicare certification is separate from the state license (state survey or CMS-approved accreditor). CMS imposed a nationwide 6-month moratorium on new Medicare hospice enrollments (including new practice locations) effective 2026-05-13, extendable in 6-month increments; applications received by the Medicare contractor before that date are still processed, accreditation cannot be used for deemed-status entry during the moratorium, and a hospice undergoing a non-exempt ownership change within 36 months of enrollment must re-enroll as new and is therefore blocked. The federal notice leaves Medicaid/CHIP hospice moratoria to each state.

Regulation

Rules for Hospice in Arkansas (20 CAR ch. 47), under Ark. Code Ann. §§ 20-7-117, 20-7-123, 20-38-101 et seq.; Ark. Code § 20-10-801 et seq.

1. Obtain a Permit of Approval (POA) from the appropriate permit agency for the proposed service area
2. File the license application under oath on Department forms (signed by owner, two officers, or head of the governmental unit)
3. Pass the Department's operational and physical plant survey
4. Receive a one-year license

Staffing

• Hospice medical director who is a physician qualified by training and experience in hospice care
• Social services provided by a qualified social worker
• Hospice aides meeting the rule's experience/training qualifications

Program

Arkansas Medicaid

Enrollment portal

Arkansas Medicaid Health Care Provider Portal (MMIS provider enrollment)

Fiscal agent

Gainwell Technologies (Medicaid Provider Enrollment Unit for the Division of Medical Services)

Application fee

Arkansas collects the fee only from the provider types on its ACA-fee list; it is payable once every five years. Individual practitioners and groups of individual practitioners (physician, dental, therapy groups) do not pay, nor do providers that already paid Medicare or another state's Medicaid. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

Arkansas requires fingerprint checks for all high-risk providers and their 5%+ owners (provider manual section 141.103) and notifies applicants by letter with instructions. Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

Arkansas requires all providers to revalidate every five years; the portal mails notices ahead of the due date and the state asks for revalidations at least 60 days early. Licenses and certifications must also be resubmitted each year. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Arkansas Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Permit of Approval (POA)

Agency

Arkansas Health Services Permit Agency (under the Arkansas Department of Health), directed by the Health Services Permit Commission

Services covered

• nursing facilities
• assisted living facilities
• residential care facilities
• home health agencies
• hospice agencies and hospice facilities
• ICF/IID
• psychiatric residential treatment facilities

Moratoria

New permits are under moratorium for ICF/IID (since 1987; data table dates it to 03/1994), residential care facilities (since 2005, except replacement RCFs of 16 beds or fewer) and psychiatric residential treatment facilities (since 2008), per the agency's SFY 2024 annual report.

Arkansas certificate of need details →

State minimum wage

$11.00 an hour

Effective

2021-01-01

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Hospice agencies (community based) — active organization NPIs (NPPES)

109 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

46 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

773,838 (as of Jun 1, 2026)

All Arkansas Hospice Medicaid rates, ranked →