How to start a skilled nursing facility in Arkansas

Arkansas requires a Nursing home license (classified as Skilled Nursing Facility, Intermediate Care Facility, or ICF/IID) from Arkansas Department of Human Services, Division of Provider Services & Quality Assurance — Office of Long Term Care to operate a skilled nursing facility. Fee: Annual license fee of 10 cents per patient bed or $10, whichever is greater (government-operated facilities exempt). Separate $3,000 Permit of Approval application fee to the Health Services Permit Agency. Processing time: Permit of Approval applications are accepted February 1, May 1, August 1 and November 1; completeness review within 30 days; decision within 90 days of a complete application; 30 days to appeal.

License required

Yes

License

Nursing home license (classified as Skilled Nursing Facility, Intermediate Care Facility, or ICF/IID)

Issuing agency

Arkansas Department of Human Services, Division of Provider Services & Quality Assurance — Office of Long Term Care

Fee

Annual license fee of 10 cents per patient bed or $10, whichever is greater (government-operated facilities exempt). Separate $3,000 Permit of Approval application fee to the Health Services Permit Agency.

Renewal

Every year

Processing time

Permit of Approval applications are accepted February 1, May 1, August 1 and November 1; completeness review within 30 days; decision within 90 days of a complete application; 30 days to appeal.

Certificate of need

Required

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

Arkansas DHS Rules for Nursing Homes (rev. 11/01/2024), §§201–202; Health Services Permit Agency rules

1. Check the Health Services Permit Agency bed-need book for available beds in the county
2. Hold a pre-submission conference with the Permit Agency
3. File the Permit of Approval application (original plus copy) with the $3,000 fee in a quarterly window
4. After POA approval, file a notarized license application with the Office of Long Term Care and pay the per-bed fee
5. Pass the licensure survey
6. For Medicare/Medicaid, complete the federal certification survey

Staffing

• Administrator licensed as a nursing home administrator
• Registered nurse responsible for nursing services named on the application

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.

Skilled nursing facilities — active organization NPIs (NPPES)

692 (as of Sep 13, 2026)

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

221 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

773,838 (as of Jun 1, 2026)

All Arkansas Skilled nursing Medicaid rates, ranked →