Arizona adult day health care facility license: ADHS rules, plan review and fees

Who needs the license, and the five-adult line

Arizona law defines an adult day health care facility as a facility that provides adult day health services for part of a continuous 24-hour period, for compensation, on a regular basis, to five or more adults who are not related to the proprietor ⁠¹. “Adult day health services” is a defined package: planned care supervision and activities, personal care, personal living skills training, meals and health monitoring in a group setting. The program may add preventive, therapeutic and restorative health-related services, but not behavioral health services ⁠¹. If you plan a day program built around counseling or behavioral health treatment, this is the wrong license; Arizona licenses behavioral health facilities under separate classes and fees ⁠⁵.

The exemption is a number. A.R.S. 36-402 exempts places where four or fewer unrelated adults receive adult day health services for pay on a regular basis ⁠². All three conditions in the definition matter: an occasional free drop-in group is outside it, while a paid, scheduled program for a fifth unrelated adult is inside it ⁠¹.

Adult day health care is its own class of health care institution in Arizona’s rules. You apply for the class that authorizes the highest level of services you intend to provide, and ADHS reviews your proposed scope of services to decide whether the class you asked for fits ⁠⁵. Do not confuse it with these neighbors:

• Assisted living facility (home or center). A 24-hour residential license from the same ADHS bureau ⁠³. See the Arizona assisted living facility license guide.
• Home health agency. Nurses and aides sent to clients’ homes; a separate ADHS license class with its own fee schedule ⁠⁵.
• Child care facility or group home. Day care for children is licensed separately. See the child care facility and child care group home guides.

The Bureau of Assisted Living Facilities Licensing licenses adult day health care facilities alongside assisted living centers and homes, adult foster care homes and nursing-supported group homes ⁠³. Rules for this business in other states are compared on the adult day care license page, and the other Arizona licenses are on the Arizona state page.

The rule text quoted here comes from ADHS’s posted copies of 9 A.A.C. 10, Articles 1 and 11, which ADHS labels unofficial and effective November 5, 2019 ⁠⁴⁠⁵. ADHS’s initial inspection checklist for adult day facilities was revised June 11, 2025 (Version 25-3) and repeats the same Article 11 figures ⁠⁶.

Building first: plan review comes before the license

In Arizona the building is the long lead item, because Article 11 ties an adult day facility to the physical plant codes ADHS incorporates by reference. R9-10-1117 requires compliance with the codes in R9-10-104.01 that were in effect on the date you submitted architectural plans and specifications to ADHS ⁠⁴. That brings in the 2018 International Building, Fire, Mechanical and Plumbing Codes, the 2012 editions of NFPA 101 (Life Safety Code) and NFPA 70 (National Electrical Code), and ICC A117.1-2017 for accessibility, each as modified by ADHS ⁠⁵.

Because those codes apply, your initial license application must include either an application for ADHS approval of architectural plans and specifications or proof that ADHS has already approved them ⁠⁵. The plans packet under R9-10-104 asks for ⁠⁵:

• A narrative of the project and the estimated total cost, broken into site acquisition, construction, architect fees, fixed equipment and movable equipment.
• A statement signed and sealed by the project architect (or engineer, where one is required).
• The building’s IBC construction type and occupancy type.
• A scaled site plan showing streets, property lines, parking, outdoor areas, fences, pools, fire access roads and hydrants, plus scaled floor and ceiling plans showing doors and windows with fire ratings, fire alarm, detection and sprinkler systems.

When construction or remodeling is finished, ADHS expects a closeout package that includes a certificate of occupancy (or documentation that one is not required), a certification from the architect and contractor that the work substantially complies with the licensing rules, and contractor certifications for any fire alarm, sprinkler or HVAC work ⁠⁵. Rule R9-10-108 gives ADHS 105 calendar days overall to act on plans: 45 days for the completeness check and 60 for substantive review ⁠⁵.

The initial application also asks whether the site is within a quarter mile of agricultural land, and if so, for the names of the agricultural landowners or lessees and a copy of your written agreement with them ⁠⁵.

What the space must include

The physical plant section is short but specific ⁠⁴:

• Indoor activity space: at least 40 square feet per participant, not counting bathrooms, halls, storage areas, kitchens, wall thicknesses or rooms used by people who are not participants. Divide your net activity space by 40 to get the most participants the rule allows.
• Outdoor activity space on the premises with a hard-surfaced section for wheelchairs, an available shaded area, and a way out without going back through the building.
• Bathrooms: at least one working toilet and one sink with running water for every ten participants; privacy; mirror, soap, paper towels or air dryer, grab bars where needed; a window that opens or other ventilation.
• Bathing, if offered: privacy, nonporous shower enclosures, grab bars and slip-resistant floors.
• Dining areas with tables and chairs, separated by a wall or other physical separation from food preparation; food areas not used as a passageway; slip-resistant flooring throughout.
• Swimming pools trigger extra equipment and a fence or wall at least five feet high that is not chain-link, with a self-closing, self-latching gate; staff test water on days participants swim, and two staff must be in the pool area when two or more participants are there ⁠⁴⁠⁶.

The premises and equipment must also be sufficient for the services in your stated scope and for each person you accept ⁠⁴.

Staffing: no ratio, but fixed minimums

Arizona does not publish a participant-to-staff ratio for adult day health care. Instead, R9-10-1106 requires “sufficient” personnel with the skills to deliver your scope of services and meet each participant’s needs, and then sets these floors ⁠⁴:

• At least two personnel members on the premises whenever two or more participants are present.
• At least one person with CPR and first-aid certification on the premises at all times.
• A registered nurse who manages nursing services and directs health-related services.
• A nurse on the premises daily to give medications and treatments and monitor participants’ health.

Every personnel member must be 18 or older and cannot be a participant. Staff, employees and volunteers who have direct contact with participants for more than eight hours a week must show evidence of freedom from infectious tuberculosis by their start date ⁠⁴. Personnel records must document qualifications, orientation, in-service training, licenses and CPR or first-aid training where required, and must be kept for 24 months after the person leaves ⁠⁴.

Administrator. Arizona sets no degree or license requirement for an adult day administrator. The governing authority writes its own qualifications for the role and must designate, in writing, an administrator who meets them. The administrator must be at least 21, and when they are off site, a written designee aged 21 or older must be present. If the administrator will be or has been absent more than 30 days, the governing authority designates an acting administrator ⁠⁴. Changes in the chief administrative officer must be reported to ADHS ⁠⁵⁠¹².

Hiring checks. ADHS’s adult day initial checklist (Version 25-3) lists A.R.S. 36-411(C) ⁠⁶. That subsection requires documented, good-faith efforts to contact previous employers, verify the status of a person’s fingerprint clearance card, and, since January 1, 2025, check the Adult Protective Services registry before hiring. Current employees had to be checked by March 31, 2025, with annual re-verification after that; a person on the registry may not be hired ⁠⁷. The same checklist lists the fall prevention and fall recovery training program of A.R.S. 36-420.01, which requires initial and continuing competency training for all staff ⁠⁶⁠⁸. That statute borrows its definition of health care institution from A.R.S. 36-420, which names assisted living, hospice, nursing care and residential care institutions ⁠⁹, but ADHS lists it on the adult day checklist, so expect the inspector to ask for it ⁠⁶. The fingerprint clearance card requirement in A.R.S. 36-411(A) is written for residential care institutions, nursing care institutions and home health agencies, and neither the statute nor the Article 11 text names adult day health care facilities; ADHS’s checklist cites only subsection C ⁠⁶⁠⁷. Ask the Bureau of Assisted Living Facilities Licensing in writing whether your staff and volunteers need fingerprint clearance cards, and if you are unsure, have them apply.

Policies to have written before the inspection

R9-10-1103 lists the policies ADHS will look for on day one ⁠⁴. In summary:

• Job descriptions, qualifications, orientation and in-service training, and who must hold CPR and first-aid certification.
• Participant rights (including help for participants who do not speak English or have a disability), complaints by participants and by staff, and a method to identify each participant.
• Screening, enrollment and discharge; the services in your scope; medication dispensing, administration and disposal, including controlled-substance diversion controls; responding to out-of-control behavior; food, environmental services, infection control, contracted services and emergency treatment.
• Medical records (including electronic records) and a quality management program with incident reporting, which the governing authority reviews at least every 12 months.

Policies must be available to staff and reviewed at least every three years. Any documentation the Article requires must reach ADHS within two hours of a request ⁠⁴. The administrator must also keep a schedule of rates available, post a monthly activity calendar before each month starts (kept 90 days), and help participants form a participants’ council ⁠⁴. Participant rights and the rights requirements must be posted on the premises ⁠⁴.

Medication policies need sign-off from a pharmacist, medical practitioner or registered nurse. Medication must be stored in a locked room, closet or unit used only for medication. Staff other than practitioners and RNs may assist with self-administration only after training from a practitioner or RN (or someone they trained) ⁠⁴.

The disaster plan must cover relocation, notifying each participant’s emergency contact, access to medications, and water and food during a disaster. It is reviewed every 12 months, with a disaster drill on each shift every three months and an evacuation drill with participants every six months. Each participant must be oriented to the exits within their first two visits ⁠⁴.

If you prepare meals, you need a food establishment license or permit under 9 A.A.C. 8, Article 1; if a caterer delivers, keep a copy of the caterer’s license. A designated food service supervisor posts menus a day ahead, prepared a week in advance and kept 60 days ⁠⁴.

Enrollment, assessment and care plan clocks

Article 11 runs on fixed deadlines that ADHS checks in participant records ⁠⁴:

Discharge is allowed only for repeated noncompliance with facility requirements, documented failure to pay, dangerous or disruptive behavior, or needs outside your scope of services ⁠⁴. Injuries that may need medical care require immediate notice to the representative and practitioner, and a report to Adult Protective Services under A.R.S. 46-454 when that statute applies ⁠⁴.

The application, in order

1. Fix your scope and participant count

   The scope of services sets your class and staffing, and your indoor space at 40 square feet per participant limits how many participants you can request. Article 11 adds one item to the general application: the number of participants you want authorized ⁠⁴.

2. Get plans approved and build

   Submit architectural plans and specifications with the plan review fee, then complete construction and the closeout documents described above ⁠⁵.

3. File the license application 60 to 120 days before you plan to open

   A.R.S. 36-422 sets that window ⁠¹⁰. The packet includes the institution’s details and tax ID, a copy of the lease if you lease, ownership documents, the name of anyone with a 10% or larger interest and any prior license denials, revocations or suspensions, the governing authority, the chief administrative officer’s degree and related experience, the plans approval, your scope of services, and the $50 application fee ⁠⁵.

4. Tell ADHS you are ready for inspection

   The application is not administratively complete until you give written notice that the facility is ready for its licensing inspection ⁠⁵. ADHS’s initial checklist is the practical self-audit for that step ⁠⁶.

5. Pass the inspection

   ADHS inspects the premises and investigates the character and qualifications of the applicant ⁠¹¹. During substantive review it may make one comprehensive written request for more information ⁠⁵.

6. Pay the licensing fee and receive the license

   After the written notice of approval, you have 60 days to pay the licensing fee (or 90 days with a $250 late fee); ADHS then sends the license ⁠⁵.

Rule R9-10-108 sets an overall time-frame of 120 calendar days for a health care institution license: 30 days for completeness and 90 for substantive review ⁠⁵. A.R.S. 36-425 requires ADHS to approve or deny within 90 days after receiving a complete initial application ⁠¹². If you do not answer ADHS’s request for more information within the time the rule allows, ADHS issues a denial, which you can appeal within 30 days ⁠⁵.

Fees

Adult day facilities share this fee schedule with assisted living homes and centers ⁠⁵. The open point is which row a day program pays. A.R.S. 36-401 defines “licensed capacity” as people expected to stay more than 24 hours ⁠¹, which adult day participants never do, and Article 11 asks you to request a number of participants, not a licensed capacity ⁠⁴. Neither the rule nor the statute says which row applies, so ADHS’s published sources do not settle whether an adult day facility pays the $280 no-capacity rate or $70 per authorized participant. Ask the bureau which row it will bill before you budget; the 1-59 row with a 30-participant program would be $280 plus $2,100, while the no-capacity row is $280. All fees are nonrefundable except as A.R.S. 41-1077 provides ⁠⁵.

Keeping the license: annual fees, inspections, changes

An Arizona health care institution license does not expire. It stays valid unless ADHS revokes or suspends it, or it becomes void because you did not pay licensing fees or civil penalties by the due date ⁠¹². ADHS notifies you at least 90 days before your annual fee is due. You submit the fee and verify your facility information no earlier than 60 days before the license anniversary, or up to 30 days after it with the $250 late fee ⁠⁵. You can ask for a different fee due date, but no more than once every three years ⁠⁵.

ADHS must inspect each facility at least once a year. An adult day facility is not one of the residential or nursing classes excluded from the deficiency-free rule, so if your compliance survey finds no deficiencies, ADHS will not conduct another routine compliance survey for 24 months, though it can still enforce the rules and enter when it has reasonable cause to believe you are out of compliance ⁠¹¹⁠¹². ADHS may also accept an accreditation report covering the licensure period from an approved national accrediting organization in place of compliance inspections ⁠¹¹. Keep the latest ADHS inspection reports at the facility and post a notice saying where they can be reviewed ⁠¹². If an inspection finds you out of substantial compliance, ADHS may issue a provisional license for up to one year while you correct deficiencies ⁠¹².

Changes that require notice ⁠⁵⁠¹⁰:

• 30 days before: a change of facility or licensee name, or of hours of operation.
• 30 days before: a change of ownership or closing. Closing also requires telling ADHS where medical records will be kept.
• Within 30 days after: any change in a controlling person.
• Immediately: a change of the chief administrative officer ⁠¹².

When a change needs ADHS approval as a modification of the facility under R9-10-110, R9-10-108 allows ADHS 75 days to act ⁠⁵.

Getting paid: AHCCCS ALTCS

Arizona’s Medicaid agency, AHCCCS, covers adult day health services for members of the Arizona Long Term Care System (ALTCS) elderly and physically disabled program through ALTCS E/PD contractors and the Tribal ALTCS fee-for-service program. Its policy is AMPM 1240-B, with effective dates of February 14, 1996, December 11, 2019 and March 1, 2023 ⁠¹³. The policy requires the ADHS license and adds requirements a licensed facility does not otherwise face ⁠¹³:

• Location in the community among other residential buildings and businesses, with active links to community activities and resources.
• Activities that support member choice and autonomy rather than regimented schedules, and a care plan that covers interests such as work or volunteering, with referral to the member’s case manager.
• Written policies on managing and documenting members’ personal funds.

ALTCS members living in an assisted living facility need special justification from their case manager and prior approval from the contractor to attend adult day health, and members living in behavioral health residential facilities are not eligible ⁠¹³.

Sources

1. 1
   Arizona State Legislature, A.R.S. 36-401: Definitions (health care institutions) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Arizona State Legislature, A.R.S. 36-402: Exemptions Checked 12 Oct 2026 · Back to text ↑
3. 3
   Arizona Department of Health Services, Assisted Living Licensing (Bureau of Assisted Living Facilities Licensing) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Arizona Department of Health Services, 9 A.A.C. 10, Article 11: Adult Day Health Care Facilities (unofficial ADHS copy, effective November 5, 2019) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Arizona Department of Health Services, 9 A.A.C. 10, Article 1: General (unofficial ADHS copy, effective November 5, 2019) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Arizona Department of Health Services, Adult Day Health Care Facility Initial Checklist, Version 25-3 (June 11, 2025) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Arizona State Legislature, A.R.S. 36-411: Fingerprinting requirements; adult protective services registry Checked 12 Oct 2026 · Back to text ↑
8. 8
   Arizona State Legislature, A.R.S. 36-420.01: Fall prevention and fall recovery training programs Checked 12 Oct 2026 · Back to text ↑
9. 9
   Arizona State Legislature, A.R.S. 36-420: Cardiopulmonary resuscitation; first aid; falls Checked 12 Oct 2026 · Back to text ↑
10. 10
    Arizona State Legislature, A.R.S. 36-422: Application for license; notification of proposed change in status Checked 12 Oct 2026 · Back to text ↑
11. 11
    Arizona State Legislature, A.R.S. 36-424: Inspections; suspension or revocation of license Checked 12 Oct 2026 · Back to text ↑
12. 12
    Arizona State Legislature, A.R.S. 36-425: Inspections; issuance of license; provisional license Checked 12 Oct 2026 · Back to text ↑
13. 13
    Arizona Health Care Cost Containment System, AHCCCS Medical Policy Manual, Policy 1240-B: Adult Day Health Facilities Checked 12 Oct 2026 · Back to text ↑

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