How to start a skilled nursing facility in Arizona

Arizona requires a Health care institution license — nursing care institution from Arizona Department of Health Services, Bureau of Medical Facilities Licensing to operate a skilled nursing facility. Fee: Application and license fees under A.A.C. R9-10-106; non-refundable except as provided in A.R.S. §41-1077. Amount not printed on the application.

License required

Yes

License

Health care institution license — nursing care institution

Issuing agency

Arizona Department of Health Services, Bureau of Medical Facilities Licensing

Fee

Application and license fees under A.A.C. R9-10-106; non-refundable except as provided in A.R.S. §41-1077. Amount not printed on the application.

Medicare certification

Separate from the state license. The state survey agency runs an unannounced standard health survey, a Life Safety Code survey and an emergency-preparedness survey against 42 CFR Part 483 Subpart B. For a Medicare SNF the state certifies and the CMS Location decides Medicare participation; for a Medicaid-only NF the state's certification is final and the state Medicaid agency decides participation.

Regulation

A.R.S. §36-422; A.A.C. Title 9, Ch. 10, Article 1 (general) and Article 4 (nursing care institutions)

1. Submit the initial health care institution license application with the nursing-care-institution supplement
2. Include a copy of the licensed nursing care institution administrator's license
3. Pay fees under R9-10-106
4. Pass the ADHS licensing inspection
5. For Medicare/Medicaid, complete the federal certification survey and enroll with AHCCCS

Staffing

• Administrator licensed under A.R.S. Title 36, Ch. 4, Art. 6

Program

Arizona Health Care Cost Containment System (AHCCCS)

Enrollment portal

AHCCCS Provider Enrollment Portal (APEP)

Fiscal agent

None — AHCCCS runs provider enrollment and its own claims system in-house

Application fee

AHCCCS charges the enrollment fee to non-individual provider types at enrollment and can charge it again at revalidation; AHCCCS lists $750 for calendar year 2026, matching Medicare's fee. 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

AHCCCS requires the fingerprint-based criminal background check (FCBC) only for high-risk provider types. 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

AHCCCS applies site visits to moderate- and high-risk provider types, at enrollment and at revalidation. 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

AHCCCS requires revalidation every four years (stricter than the federal five) and may call for off-cycle revalidation; providers get 90 days from notice or their enrollment is terminated. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Arizona Medicaid enrollment guide →

CON program

No

Agency

Arizona Department of Health Services (ambulance certificates of necessity only)

Arizona certificate of need details →

State minimum wage

$15.15 an hour

Effective

2026-01-01

Scheduled increases

Rises to $15.65 on 2027-01-01 (annual CPI adjustment announced by the Industrial Commission).

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.

Skilled nursing facilities — active organization NPIs (NPPES)

366 (as of Sep 13, 2026)

Medicare/Medicaid-certified nursing homes (CMS Care Compare)

140 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,611,827 (as of Jun 1, 2026)

All Arizona Skilled nursing Medicaid rates, ranked →