Arkansas adult day care license: DPSQA rules, slots, staffing and the Act 905 question

Two licenses, one agency

The Arkansas Department of Human Services licenses daytime care for adults through its Division of Provider Services and Quality Assurance (DPSQA). The division issues two separate licenses: Adult Day Care (ADC) and Adult Day Health Care (ADHC) ⁠⁴. The Medicaid side is separate again. DPSQA certifies Adult Day Services (ADS) and Adult Day Health Services (ADHS) providers for Medicaid, and that certification comes on top of the license ⁠⁴.

Both licenses use the same base definition: a program for four or more functionally impaired adults, for more than two but less than 24 hours a day, somewhere other than the adult’s own home ⁠¹⁠³. The difference is the level of care:

• ADC (20 CAR Part 408) is a supervision-and-assistance program. Clients must be able to take their own medications, and anyone who is bed-fast cannot be admitted ⁠².
• ADHC (20 CAR Part 409) provides “organized and continuing supportive health and social services.” It needs a full-time Health Care Coordinator, who must be a licensed nurse, and one paid full-time direct-care staff position for every five clients ⁠³.

This guide covers the ADC license. If your business plan includes giving medications, monitoring medical regimens or serving people who cannot manage their own pills, you are planning an ADHC (see the section near the end).

Neither license is on the Health Services Permit Agency’s Permit of Approval list. That list covers nursing facilities, residential care facilities, assisted living facilities, home health and hospice agencies, psychiatric residential care facilities and ICF/IIDs ⁠¹². That is a real difference from an Arkansas assisted living facility or a residential care facility, where the permit comes before anything else. DPSQA’s Information for Providers page says new long-term care facilities need a permit from that agency without listing types ⁠⁵, so confirm with DPSQA that none applies to your program.

Who needs the license, and the Act 905 wrinkle

Under the rule, an ADC program “provides care and supervision to meet the needs of four (4) or more functionally impaired adults for periods of less than twenty-four (24) but more than two (2) hours per day in a place other than the adult’s own home” ⁠¹. A functionally impaired adult is anyone 18 or older who needs care and supervision because of a mental or physical disability ⁠². The rule says no ADC facility may be “established, conducted, or maintained” without first getting a long-term care facility license under Ark. Code Ann. § 20-10-201 et seq. ⁠¹. It also says a facility may not admit clients until the license is issued ⁠¹.

The same rule has carried a carve-out since June 1, 2022. Act 905 of 2021 changed the statutory definition, and DPSQA copied it into the ADC rule: a “long-term care facility” does not include an adult day care program that serves twelve or fewer functionally impaired adults at any time, or that serves clients four hours or less per day for no more than two days per week ⁠¹⁠⁸. DPSQA sent ADC providers an advisory memo about the change on June 1, 2022 ⁠⁷.

Neither the rule nor the memo says what happens to licensing for programs inside the carve-out. The rule still defines ADC as four or more adults, and the license it requires is a long-term care facility license ⁠¹. The official sources do not say whether a program serving 5 to 12 adults, or running 4 hours or less on 2 days a week or fewer, still needs an ADC license. If your program falls in that range, ask DPSQA’s Licensure & Certification Manager (501-396-6153) or [email protected] ⁠⁷ whether it must be licensed, and keep the answer in writing. You will need the license anyway if you want Medicaid ARChoices money (see below).

Programs that are not ADC under these rules include:

• Care for three or fewer adults, or for two hours or less a day ⁠¹.
• Care in the adult’s own home. That is in-home care, licensed through the Department of Health as a private care agency or home health agency.
• Overnight (24-hour) care, which falls under residential care or assisted living licensing.

Choosing and preparing the building

Arkansas sets out the building rules in Subparts 6 and 7 of Part 408. Your site choice has to come first, because the initial application must include floor plans with exact measurements ⁠¹.

At 40 sq ft per person, a 30-slot program needs 1,200 sq ft of countable activity space before you add offices, restrooms, storage, the quiet room and the kitchen. The rule’s toilet formula and its own 35-slot example (4 fixtures) do not agree, so get DPSQA’s count for your slot number before you build ⁠¹.

Furniture must be sturdy enough that a client can lean on it without it tipping. You need at least one comfortable chair per participant, and enough table space and chairs to serve everyone a meal at the same time ⁠¹.

Fire safety is local first. A facility in an organized area or municipality must get an annual written certification from local fire officials that it meets local fire codes. If there are no local codes, or DPSQA finds them inadequate, NFPA 101 Life Safety Code, Section 16 (2000 edition) applies ⁠¹. Emergency lighting must meet NFPA 101 section 16.2.9 (2000 edition) ⁠¹.

If you cook on site, you must keep at least a 24-hour supply of perishable food and a 3-day supply of non-perishable food. All food must come from a source the Department of Health approves, and you must follow state, county and local food-sanitation rules ⁠². An ADC attached to another licensed long-term care facility may use that facility’s kitchen ⁠². If you use a caterer, keep the caterer’s current inspection report on file ⁠¹.

What goes in the application

The application is the DMS-744, a combined form for residential care, adult day care, adult day health care and post-acute head injury facilities (version 01/13). It must be completed in ink or typed and notarized, and the form’s instructions name who signs by ownership type (the owner for a sole proprietorship, one of the partners for a partnership; a public facility is signed by the head of the governing department) ⁠⁶. The form lists every corporate officer and anyone who owns 5% or more ⁠⁶. The form’s instructions say to send it by certified mail to DHS Office of Long Term Care, P.O. Box 8059, Slot S408, Little Rock, AR 72203 ⁠⁶. DPSQA’s Enterprise Licensing System (ELS) now handles new license applications, renewals, electronic fee payment and survey reports ⁠⁹. ADC and ADHC are among the provider types DPSQA trained on ELS when it launched on August 1, 2022 ⁠¹⁰. DPSQA’s ELS page says providers can apply for new licenses in ELS, but no official source says whether a paper DMS-744 is still accepted for a new ADC, so ask DPSQA which route to use before you file ⁠⁹.

The rule lists what must come with an initial application ⁠¹:

• Floor plans with exact measurements, identifying every room, hallway, window and exit.
• A zoning letter from the city or county zoning commission stating that the facility meets zoning requirements.
• A letter from a licensed electrician and a licensed plumber, giving their names and license numbers, stating that the facility complies with state codes.
• A County or State Health letter approving the well and septic system, if you have them.
• Ownership disclosure: everyone with a direct or indirect ownership interest of 5% or more. Corporations add each officer and director and a certificate of good standing from the Arkansas Secretary of State. Partnerships add each partner and a copy of the partnership agreement.
• The license fee: $5.00 per slot (see below).

Choose the facility name carefully. Every owner must give the facility a distinctive name on the application, and it cannot be changed later without prior written approval ⁠¹. A license covers only the premises and persons named. Separate sites need separate licenses, but several buildings on contiguous land are licensed together under one license ⁠¹.

The licensing sequence

20 CAR 408-205 sets out the order for a new facility ⁠¹⁠²:

1. Get the forms

   You get the initial application forms from the licensing office. The rule notes that receiving a form does not guarantee a license ⁠¹.

2. File everything at once

   Submit the completed forms, all fees and the facility plans together ⁠¹.

3. Life Safety Code survey

   For a new facility, the department surveys the building against the applicable building codes ⁠².

4. Building clearance

   Once you are told the facility meets all applicable building codes, the rule says you may admit clients ⁠². The same rule also bars admitting clients before a license is issued ⁠¹, so confirm with your surveyor which event applies before you enroll anyone.

5. Initial survey and license

   After you pass the initial survey, the license is issued. It takes effect on the date the office sets once it finds you in compliance ⁠¹⁠².

6. First expiration

   Whatever month it starts, the license expires on the June 30 after it is issued ⁠¹.

The rule does not set a processing deadline for initial applications.

Fees and the renewal calendar

As published on October 12, 2026, 20 CAR 408-205 sets the fee at $5.00 per slot. You pay it in advance for initial licensure, renewal, or relicensure after a change of ownership, and it is refunded if a license is not issued ⁠¹. A 30-slot program pays $150 a year. The slot number printed on the license is a hard cap: except when DPSQA waives it in an emergency, you may not have more slots, or accept more clients, than the license states ⁠¹.

Every ADC license in the state runs July 1 through June 30, and renewal is annual ⁠¹. The renewal application must be delivered, or postmarked, by June 1. Fees received after June 1 carry a 10% penalty, and a license that is not renewed by June 30 is void ⁠¹. The older DMS-744 instructions say March 1 ⁠⁶, and DPSQA’s Information for Providers page says long-term care renewals and fees are due by the anniversary of the license issue date ⁠⁵. The rule says June 1. Check the date DPSQA puts on your renewal notice.

DPSQA may survey a facility before renewing it. It may also refuse renewal if civil money penalties are unpaid after appeals end, and it must deny renewal if the facility cannot meet program requirements ⁠².

Staffing, qualifications and training

Ratio. You must have at least two staff whenever 2 to 16 clients are present, and one more for any portion of eight additional clients ⁠¹. Seventeen clients therefore means three staff, and 25 clients means four. Secretaries, accountants and other non-direct-care staff do not count, except that one non-direct-care person may fill in during an emergency until it is resolved ⁠¹. DPSQA can require more staff if clients’ needs are not being met ⁠¹. Staff who are doing housekeeping, laundry or kitchen work still count as direct care, as long as they follow universal precautions ⁠².

Director. A program licensed for more than 15 clients must have a full-time director ⁠¹. Any director must be at least 21, have at least one year of work experience in human services (for example, with elderly or disabled adults), have shown ability in supervision and administration, hold a current health card, and know the aspects of aging and activity programming ⁠¹. The director signs the license application and must pass a criminal background check ⁠¹. If the executive director runs more than the adult day program, they cannot be counted as direct care staff ⁠².

Personal care staff. Personal care staff must be at least 18, hold a current health card, and have completed a nurse aide, personal care technician or home health aide training course ⁠².

Volunteers. Volunteers who give direct care must be 18 or older, hold a health card, have a written job description, go through orientation, and be supervised by a named paid staff position. They count toward the ratio only if they have the same qualifications as the staff position they replace ⁠².

Screening before hire. Before anyone starts work, including contract staff, you must check the Office of Long-Term Care Employment Clearance Registry and the Adult and Long-Term Care Facility Resident Maltreatment Central Registry, and recheck every employee every five years ⁠¹. Staff must also pass a criminal background check under Ark. Code Ann. § 20-33-201 et seq. ⁠¹. The rule ties that check to the criminal record check rules at 20 CAR Part 404, which the Code of Arkansas Rules now lists as repealed ⁠¹⁠¹³. The Code of Arkansas Rules says Part 404 was repealed by Ark. R. 2026-83, effective July 1, 2026, and no official source reviewed names its replacement ⁠¹³. Ask DPSQA which procedure applies to ADC staff.

Every employee’s orientation must cover job duties, client rights, abuse and neglect reporting, and fire and tornado drills ⁠². Anyone who supervises or helps with medications also needs annual training on your medication policies ⁠².

Policies, clients and day-to-day records

Before the survey, have written policies ready for client care, admission, discharge, incident and abuse reporting, client rights, fire safety, smoking, emergency treatment, medication storage and administration, and emergency relocation ⁠².

Admission. Each client must be a functionally impaired adult with a current medical history on file. Clients on a Medicaid waiver also need a written plan of care ⁠². You may not admit anyone who is bed-fast, cannot take their own medications, or has behavior that endangers themselves or others ⁠².

Medications. Clients take their own medications. Staff may read the label to them, remind them, hand over the container, open it, and, for a client who is physically impaired but cognitively able, help get the dose to the mouth ⁠². Each client’s record must say who stores the medication and whether the client self-administers ⁠².

Admission agreement. Each client signs a written agreement that lists every charge and the maximum monthly, weekly, daily or hourly rate. It must promise at least 30 days’ written notice before charges change and pro-rata refunds of advance payments ⁠².

Services. You must provide help with walking, toileting, feeding, grooming and dressing; help with diets; health counseling; minor first aid; and help arranging outside therapies. Post a monthly activity schedule that includes exercise, recreation and social activities ⁠². Make balanced meals and snacks available, and notify the family if a client will not eat regular meals for more than two days in a row ⁠².

Transportation (optional). If you transport clients, drivers need a valid Arkansas license, liability insurance must be in force, everyone must wear seat belts, and wheelchair vans need locking mechanisms ⁠¹.

Drills. Hold fire drills every quarter, a disaster drill and a tornado drill every year, and safety training for staff and volunteers every six months. Keep 12 months of drill and detector records ⁠¹.

Surveys, incident reports and enforcement

The department, its agents and the Attorney General’s office may inspect at any time. Surveys can be regular or unannounced, and complaint investigations are also part of keeping the license ⁠¹. After a survey you have 15 business days to send an acceptable plan of correction. You must post the latest statement of deficiencies and your response where clients and visitors can see them ⁠¹.

Alleged abuse, neglect, misappropriation of client property or exploitation must be reported no later than 11:00 a.m. on the next business day after you discover it ⁠¹. The rule still describes faxing form DMS-731. DPSQA moved incident and accident reporting into ELS on September 1, 2023 ⁠¹⁠⁹.

Enforcement can include directed plans of correction, directed in-service training, state monitoring, a temporary director, a ban on new admissions, civil money penalties and termination of the license ⁠¹.

Selling or buying a center

A buyer must file a new application and fee, request an inspection, and meet the standards, including life safety codes, at least 30 days before the sale closes. The seller must report the change in writing 30 days ahead ⁠¹. The buyer becomes responsible for remedies imposed for problems that happened before the sale. Civil money penalties for those earlier problems stay with the seller ⁠¹. Changes that count as a change of ownership include a partnership dissolving, a corporate merger or purchase, and a switch between for-profit and nonprofit status. Changes in board membership do not count ⁠¹.

Getting paid: ARChoices certification

Arkansas Medicaid’s ARChoices in Homecare waiver pays for Adult Day Services and Adult Day Health Services. To be certified as an ADS provider, you must first hold the Office of Long-Term Care adult day license. ADHS certification requires the ADHC license ⁠¹¹. You apply with the ARChoices provider certification application ⁠¹¹. Licensed adult day and adult day health facilities can also be certified for facility-based respite care under ARChoices ⁠¹¹. The rule’s admission section expects a written plan of care for clients on an approved waiver ⁠².

When you actually need the ADHC license

20 CAR Part 409 uses the same fee ($5.00 per slot), the same July 1 to June 30 license year and the same June 1 renewal deadline as the ADC rule ⁠³. The staffing is much heavier ⁠³:

• Ratio: one paid full-time direct-care staff position for every five clients.
• Nurse coordinator: a full-time Health Care Coordinator who checks vital signs, monitors medical regimens and administers medications. The coordinator must be an Arkansas-licensed nurse, and may be an LPN working under an RN’s supervision.
• Director: a full-time director if licensed for more than 15. At 15 or fewer, one person may serve as both director and Health Care Coordinator if they meet the qualifications for both jobs.

If your client base includes people who cannot take their own medications, an ADC license will not let you serve them ⁠². Plan for ADHC from the start. See Arkansas care licenses by state and the adult day license overview to compare.

Recent changes and open items

• June 1, 2022: Act 905 of 2021 took small and part-time programs out of the definition in the ADC rule. The rule also now refers to “the department” in many places where it used to say “Office of Long Term Care” ⁠⁷⁠⁸.
• August 1, 2022: ELS launched for DPSQA licensing. Incident and accident reporting moved into it on September 1, 2023 ⁠⁹⁠¹⁰.
• Codification: the ADC rule now lives at 20 CAR Part 408 and the ADHC rule at 20 CAR Part 409. The 2022 DHS manual has the same requirements under the old section numbers ⁠¹⁠²⁠³.
• Background check rules: the criminal record check rules at 20 CAR Part 404, which Part 408 still cites, are listed as repealed ⁠¹³.

Sources

1. 1
   Code of Arkansas Rules (Arkansas Bureau of Legislative Research), 20 CAR Part 408: Rules for Adult Day Care Providers Checked 12 Oct 2026 · Back to text ↑
2. 2
   Arkansas Department of Human Services, Rules for Adult Day Care Providers in Arkansas (R. 06/01/2022) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Code of Arkansas Rules (Arkansas Bureau of Legislative Research), 20 CAR Part 409: Rules for Adult Day Health Care Providers in Arkansas Checked 12 Oct 2026 · Back to text ↑
4. 4
   Arkansas Department of Human Services, DPSQA, How to Become a Provider: Licensing, Requirements, and Processes Checked 12 Oct 2026 · Back to text ↑
5. 5
   Arkansas Department of Human Services, DPSQA, Information for Providers Checked 12 Oct 2026 · Back to text ↑
6. 6
   Arkansas Department of Human Services, Office of Long Term Care, DMS-744 (01/13): Application for License to Conduct a Long Term Residential Care, Adult Day Care Facility, Adult Day Health Care or Post Acute Head Injury Checked 12 Oct 2026 · Back to text ↑
7. 7
   Arkansas Department of Human Services, DPSQA, Advisory Memo: Long-Term Care Facility, Adult Day Care Programs (June 1, 2022) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Arkansas Department of Human Services, DPSQA, Notice of Rule Making: Revised Definition of Long-Term Care Facility (Adult Day Care), effective June 1, 2022 Checked 12 Oct 2026 · Back to text ↑
9. 9
   Arkansas Department of Human Services, DPSQA, Enterprise Licensing System (ELS) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Arkansas Department of Human Services, DPSQA, Advisory Memo: Enterprise Licensing Solution (ELS) Provider Trainings (August 1, 2022) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Arkansas Department of Human Services, ARChoices Provider Services Requirements Checked 12 Oct 2026 · Back to text ↑
12. 12
    Arkansas Department of Health, Arkansas Health Services Permit Agency Checked 12 Oct 2026 · Back to text ↑
13. 13
    Code of Arkansas Rules (Arkansas Bureau of Legislative Research), 20 CAR Part 404 [Repealed] Checked 12 Oct 2026 · Back to text ↑

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