Arkansas assisted living facility license: Permit of Approval, Level I and Level II

The Permit of Approval comes before the license

In most states, you apply for an assisted living license and the agency inspects your building. Arkansas puts a bed-allocation step in front of that. Both the Level I and Level II rules say: “No license shall be issued without proof of a valid, current Permit of Approval issued by the Health Services Permit Commission or Health Services Permit Agency.”⁠¹⁠² The Health Services Permit Agency (HSPA) sits in the Arkansas Department of Health. A nine-member commission directs it, and it issues Permits of Approval (POAs) for nursing facilities, residential care facilities, assisted living facilities, home health and hospice agencies, and a few other provider types.⁠⁷ Its office is at 906 Broadway, Suite 200, Little Rock, phone 501-661-2509.⁠⁷

The POA sets your size. OLTC’s initial license “shall state the number of beds as set forth in the Permit of Approval,” and you may not operate more beds or admit more residents than the license states.⁠¹ Licenses and their beds cannot be transferred to another owner or moved to another site.⁠¹

There are two ways to skip a new POA:

• Buying an existing facility. “The obligation of a capital expenditure to acquire an existing healthcare facility shall not require a permit of approval.”⁠⁶ The buyer still needs a change-of-ownership license from OLTC (see below).
• Converting an old residential care facility. POAs held by residential care facilities when Act 1230 of 2001 took effect, or held by later buyers of those facilities, also count as assisted living POAs “without further action.” The facility must still meet the assisted living rules.⁠¹

A new POA may also come by transfer from an existing holder. That takes its own HSPA application, and a permit cannot move to another county unless the methodology allows it.⁠⁶

Does your project need an assisted living license?

Arkansas defines an assisted living facility as any building, section or distinct part of a building, for profit or not, that provides “assisted living services for a period exceeding twenty-four (24) hours to more than three (3) adult residents of the facility who are not relatives of the owner or administrator.” The definition also covers facilities that provide those services through contracts or arrange contracts in residents’ names.⁠³⁠¹ So the first unrelated resident who triggers licensure is the fourth.

Arkansas has two other residential licenses a founder may weigh against the ALF:

• Residential care facility (RCF). This is a board-and-care license for residents who are independently mobile. DHS states that “effective July 1, 2005, the Arkansas Department of Health has issued a moratorium on new Residential Care Facility (RCF) bed licenses.”⁠¹¹ In practice, a new residential project in Arkansas is an ALF project unless you buy existing RCF beds. See the Arkansas residential care facility guide.
• Nursing home. Neither ALF level may keep a resident who needs 24-hour nursing care. Level I may not house anyone who meets nursing-home medical eligibility at all.⁠¹⁠²

If your residents go home at night, look at the Arkansas adult day care license. If you plan to send caregivers into private homes, look at the Arkansas private care agency license.

Level I or Level II: decide before you file for a permit

The POA application asks you to check “Assisted Living Level I or II” and to state the county bed need.⁠⁸ Pick the level before you apply, because it drives your staffing budget, your building layout and your payer mix.

Sources: ⁠¹⁠²⁠¹²

A Level II license “shall also be a grant of licensure as a Level I assisted living facility,” but OLTC issues a separate license for each level showing that level’s beds.⁠² A Level II building must keep “physically distinct parts or wings” for residents who receive or qualify for nursing-home level of care. Level I residents may live in Level II units, and they count toward Level II staffing there. A Level II resident may never be housed in a Level I unit or bed, and common areas must meet Level II standards.⁠² A Level I facility can later apply to become Level II without an additional fee, but it must then meet the International Building Code in effect at the time of licensure or construction, whichever is later.⁠¹

How the Health Services Permit Agency decides on beds

The bed-need formula

The methodology projects assisted living need at “thirty (30) beds per one thousand (1000) persons who are sixty-five (65) years of age and older,” projected five years forward with University of Arkansas at Little Rock census data.⁠³ Existing and proposed ALF beds and existing and proposed RCF beds in the county all count against that need.⁠³ There is one exception. When occupied beds in all facilities in a county are 75% occupied by residents documented as under 65, those beds are left out of the county’s count.⁠³ The service area is the county, and no single applicant can be awarded more than 75 beds per county per review cycle under the population-based method.⁠³

What the October 2026 numbers show

HSPA publishes the results in its Bed Need Book. The edition dated October 2026 (updated September 30, 2026) counts 9,853 ALF and RCF beds statewide against a projected 2031 need of 18,462, for a statewide net need of 8,609 beds.⁠⁹ Most counties have room. Three show negative need, which makes a new population-based application there an uphill case: Dallas (−3), Hempstead (−10) and Nevada (−7).⁠⁹ The largest net needs include Benton (710), Pulaski (636) and Washington (492).⁠⁹ Check the current edition for your county before you option land. The book is updated and the numbers move as permits are awarded.

Review criteria and who gets an unfavorable review

The commission reviews whether the project is needed. That review includes “a detailed business plan that includes a narrative description with supporting data and analysis” of need in the proposed service area.⁠³ An existing nursing home that wants to add assisted living gets an unfavorable review if, in the 12 months before filing, it had two Class A violations, two Class B violations, a Class A and a Class B, an H-level or higher deficiency, or its Medicaid or Medicare provider agreement terminated. An existing assisted living or residential care facility applying for more beds gets the same result on the Class A/Class B tests.⁠³ An application is denied if the owner or operator has abandoned a long-term care facility in Arkansas or another state, and no application is approved that would take a facility over 100 beds without special consideration by the commission.⁠³

What the POA application asks for

The HSPA form recommends a pre-submission conference with agency staff by appointment.⁠⁸ You submit one original, signed in blue ink, and one copy, with the fee, following the batching schedule.⁠⁸ For new construction, the form requires:⁠⁸

• a letter from the local Planning Commission stating that the property is properly zoned;
• proof of an option on the site or of land ownership;
• original financing commitment letters signed and dated within 90 days of the application due date (a loan commitment, proof of deposit, or an audited statement showing retained earnings);
• a three-year pro forma budget, plus capital cost, working capital and debt-service figures.

So zoning is settled locally before you file, not after you win a permit.

Filing dates, fee and decision deadlines

Source: ⁠⁴

The review fee is $3,000 “for all reviews.”⁠⁴ HSPA decides whether your application is complete within 30 calendar days and may allow up to 15 more days for missing information. An application that does not substantially address any one criterion is returned and dropped from that cycle.⁠⁴ By statute, the agency must approve or deny within 90 days of the date the application is deemed complete.⁠⁴ Opponents have 30 days from the public notice to file written comments, and you have until the 50th day of the cycle to respond. Either side can appeal the agency’s decision within 30 days.⁠⁴

The clock after you win

A POA is not open-ended. You have nine months from issuance to sign a construction contract. The contract must call for the foundation within six months of signing and completion within 18 months of signing, and the license must be obtained within 15 months of the foundation due date.⁠⁵ You must send HSPA progress reports when the contract is due, when the foundation is due, and every six months after that until you are licensed. Missing them can lead to a show-cause hearing on termination.⁠⁵

Building rules OLTC applies

Site and plans

OLTC must inspect and approve the building site “before construction is begun.”⁠¹ The site must drain well, must not be near flood-prone, industrial, airport, railway, penal or cemetery locations, and must include at least as much area for walks, drives and lawn as the building’s own square footage.⁠¹ It must also give residents an exercise area with walkways and benches. That area can be off-site, such as a park, if long-term arrangements satisfy OLTC.⁠¹

For new buildings, additions or major alterations over $100,000, plans and specifications go in duplicate to OLTC and to the Arkansas Department of Health Plumbing Division. They must be prepared by an Arkansas-licensed architect or engineer, with a cost estimate attached.⁠¹ OLTC has at least three weeks to review, and “construction cannot start until approval of plans and specifications have been received from the OLTC.”⁠¹ New construction follows the 2000 International Building Code for I-1 occupancies and the ADA.⁠¹ For fire safety, the building must meet local requirements based on NFPA 101 (1985) or IBC 2000. If the locality has not adopted those codes, or OLTC finds the local rules inadequate, IBC 2000 applies with the NFPA standards it references.⁠¹ You must also give OLTC documentation that the location complies with local zoning.⁠¹

Apartments, not rooms

Arkansas assisted living is apartment-based. Each unit must have:⁠¹

• an individual lockable entrance, with keys or codes for the resident (and building keys for residents without a credible dementia diagnosis);
• at least 150 sq ft per person or 230 sq ft for two in new construction, excluding entry, bathroom and closets, with no more than two people per unit;
• a separate, complete bathroom with toilet, tub or shower, and sink;
• a kitchen area that is visually and functionally distinct, with a small refrigerator with freezer, food cabinet, bar sink with hot and cold water, and outlets for small appliances;
• a call system monitored 24 hours a day by staff in the facility;
• telephone and TV hookups and a USPS-compliant private mailbox;
• an individual thermostat (in facilities licensed after the rules took effect), with HVAC able to hold 68 to 80 degrees all year.

Residential care facilities that were licensed or held a permit as of April 2, 2001 can convert with smaller rooms: 150/230 sq ft, or 100/180 sq ft if the room has a half or full bath or shares a bathroom with one other room. Each room still needs a small refrigerator and a microwave.⁠¹

The administrator

Every ALF needs a full-time administrator, meaning 40 hours a week, on the premises during normal business hours.⁠¹ The administrator must name a stand-in before leaving during the day shift and must notify OLTC in writing of any absence of seven or more consecutive days.⁠¹ Minimum qualifications under both rules:⁠¹⁠²

• at least 21 years old, with a high school diploma or GED;
• a clean criminal background check under the long-term care rules, no substantiated abuse, neglect or misappropriation finding, and no prior conviction under Ark. Code Ann. § 20-10-401;
• certification as an Assisted Living Facility Administrator through an OLTC-approved program.

On certification, the two levels differ. A Level I administrator may be enrolled in a program with completion expected within 12 months. Until ALF certification programs are in place, RCF administrator certification or a nursing home administrator license may be used.⁠¹ A Level II administrator must finish within four months of hire, and administrators “who are not certified within this time period may no longer work as an Assisted Living Facility Administrator.”⁠² The administrator gives OLTC a copy of their current certification every year, and again at licensure, renewal or a change of administrator.⁠¹

One administrator can run several long-term care programs in one building if they hold the right credential for each. A second, part-time administrator is required once total beds exceed 70 and each program exceeds 20 beds. The second administrator must be full-time once each program exceeds 40.⁠¹

Staffing and training

Level I staffing table

Scroll the table sideways to see every column.

Source: ⁠¹

Staff count only when they are on the premises, awake and able to meet residents’ needs. Someone responsible must be on site 24 hours a day.⁠¹ In a Level I facility of 16 or fewer residents, the administrator can count as the direct care worker while doing administrative duties. Larger facilities can count the administrator only on shifts with no administrative duties.⁠¹ A facility of 16 or fewer needs an electronic system such as pagers or cell phones to call relief staff, and the on-duty worker may not leave until relief arrives. Larger facilities need a relief person available.⁠¹ Housekeeping, laundry and dietary staff count as direct care staff if they follow universal precautions.⁠¹

Level II staffing

Level II replaces the table with ratios. You need one staff person per 15 residents from 7 a.m. to 8 p.m., one per 25 from 8 p.m. to 7 a.m., and “in no event shall there be fewer than two (2) staff persons on-duty at all times, one of which shall be a CNA.” Staff who live on site but are asleep do not count.⁠² Flex shifts are allowed if you notify OLTC in writing of the shift hours.⁠² You must employ or contract with at least one RN. The RN need not be on site but must be reachable by phone or pager, and oversees LPN, CNA and personal care aide staff. You must also employ or contract with LPNs, who may administer medication, and employ CNAs.⁠²

Training clock for every hire

All staff and contracted personnel who serve residents (other than licensed home health agency staff) are trained on this schedule:⁠¹

• Within 7 days: building safety and evacuation, emergencies, abuse and exploitation reporting, incident reporting, sanitation and food safety, resident health, job duties, assisted living philosophy, and the Residents’ Bill of Rights.
• Within 30 days: medication assistance or monitoring, and communicable diseases and infection control.
• Within 180 days: communication skills, the aging process and disability sensitivity.
• Every year: at least 6 hours of in-service training for direct-contact and food service staff.
• Dementia: 4 hours of initial training for covered staff within 90 days of hire, repeated after a lapse of 24 months or more.

Before hiring anyone, including contract staff, check the OLTC Employment Clearance Registry and the DHS Adult Abuse Register, and recheck every five years. Employees must be at least 18 and complete the long-term care criminal background check.⁠¹

Alzheimer’s special care units

If you advertise a dementia unit, the Alzheimer’s Special Care Unit (ASCU) standards apply on top of the base license. The floor plan must not route visitors or staff through the unit. You need a multipurpose room and secured outdoor walkways that prevent undetected exit.⁠¹ ASCU staffing is calculated on the unit’s own census, separately from the rest of the ALF, and the rule intends ASCU staff to be “separate and distinct.”⁠¹ A social worker, RN, physician or psychologist must complete social histories and support monthly family support groups.⁠¹ Training is 30 hours in set subjects, such as four hours on behavior management and four on activity programming. New ASCU staff must finish within five months of hire at no less than eight hours a month, followed by at least two hours of in-service every quarter.⁠¹ Families receive a disclosure statement before admission, and the Department must approve it before use.⁠¹

Who you can admit and keep

A Level I facility may not serve residents who need 24-hour nursing (except nursing certified by a licensed home health agency for 60 days with one 30-day extension), who are bedridden, whose transfer or evacuation needs exceed your staffing, or who are dangerous.⁠¹ Short-term health care in Level I comes “under the direction of a licensed home health agency,” which is one reason ALF operators often work with a home health agency.⁠¹ Facility staff may not administer, repackage or relabel medication, except as the Nurse Practice Act allows.⁠¹

Level II drops the home-health exception for 24-hour nursing. It allows residents with a temporary condition lasting more than 14 days, or a terminal condition, if a physician or advanced practice nurse certifies that a service agreement can safely meet their needs.⁠² At either level, a resident who becomes unable to recognize danger or make decisions may stay only with a guardian or health care agent, for no more than 90 days at a time and no more than two 90-day periods in 12 months.⁠¹ Involuntary discharge normally requires 30 days’ written notice.⁠¹

Applying to OLTC, step by step

OLTC licenses assisted living within DHS’s Division of Provider Services and Quality Assurance. The licensure line for assisted living, residential care and adult day programs is 501-396-6153.⁠¹⁰ DPSQA takes applications at [email protected] and says completed applications are assigned to a specialist within two business days.⁠¹¹

1. Get the POA

   File with HSPA in a batching cycle and win the beds (see above).⁠⁴

2. Get site and plan approval

   OLTC inspects the site, then approves architect-sealed plans before construction starts.⁠¹

3. Request the forms from OLTC and file

   Submit the completed forms with the fees and the building plans and floor plan.⁠¹ You must disclose every person with a 5% or greater ownership interest. A corporation lists its officers and directors and attaches a Certificate of Good Standing from the Arkansas Secretary of State. A partnership attaches its partnership agreement.⁠¹ You also submit service contracts and a signed statement that the facility will repay lost or stolen resident funds within 10 working days.⁠¹ You report on your administrator, management company and building owner, and on every other facility any of them owns or runs.⁠¹ The operator signs and passes a criminal background check.⁠¹

4. Ask for the life-safety code survey in writing

   when you file. OLTC conducts it unannounced.⁠¹

5. Admit residents once the building passes

   For a new facility, admissions may begin “upon being informed that the facility meets all requirements for all applicable building codes.”⁠¹

6. Ask for the initial survey in writing

   after residents move in. OLTC conducts it unannounced, and the license is granted when you pass. OLTC may also choose to survey before issuing the license.⁠¹

OLTC may deny a license if your administrator, directors or management company has ever been convicted of a felony, or if you or they have had a license revoked or a Class A violation found at another facility.⁠¹

Fees as published on 2026-10-12

Sources: ⁠¹⁠²⁠⁴

For a 40-bed facility, the full-year amount is $650 ($250 plus 40 × $10). Fees on a new license are prorated from the approval date through June 30, and after that you pay $650 a year, on top of the one-time $3,000 HSPA review fee.⁠¹⁠⁴ On a change of ownership, all outstanding quality assurance fees and license fees must be paid before OLTC approves the buyer.⁠¹

Renewal, surveys and ownership changes

The rules are not consistent about license term. Section 401.1 of both rules says licenses are “effective without expiration” unless revoked, suspended or terminated. Section 403 of the Level I rule says the initial license “will expire on June 30th following the issuance.” Section 404.4 requires annual fees by the anniversary of issuance.⁠¹⁠² DHS’s provider page says each license “is renewed annually,” with renewals and fees due by the anniversary date and penalties for late renewals.⁠¹⁰ Plan on the annual anniversary renewal and confirm the date with OLTC.

OLTC runs a standard survey “on an average of every eighteen (18) months” and may inspect unannounced at any time.⁠¹ To change your management company or operator, notify OLTC and get approval at least 30 days in advance (within 10 days afterward in an emergency).⁠¹ A sale requires 30 days’ written notice from buyer and seller. The buyer gets a provisional license on filing, which carries all the rights of licensure except Medicaid or Medicare provider status.⁠¹ Leasing any part of the real or personal property counts as a change of ownership. So does converting between for-profit and nonprofit status.⁠¹

Getting paid through Living Choices (Level II only)

Arkansas Medicaid pays for assisted living through the Living Choices Assisted Living waiver, a 1915(c) home and community-based services program. “Licensed Level II ALF are qualified to enroll with Medicaid as Living Choices Assisted Living Facilities—Direct Services Providers, if all other requirements for enrollment are met.” A licensed Class A home health agency may also become the Living Choices provider by contracting with a Level II ALF.⁠¹² The waiver serves people 65 and older, and people 21 through 64 with a physical disability, who qualify for nursing home admission at the intermediate level of care. Medicaid does not pay room and board.⁠¹² The posted provider-manual packet is the 2021 proposed-rule text, so ask DHS which version of the Living Choices provider manual is in force before you rely on its wording.

Because Living Choices is a home and community-based service, Medicaid-enrolled Level II facilities must meet the federal HCBS Settings Rule. DHS says “each ALF II provider will undergo an individualized HCBS Settings Review,” with continuing checks during annual licensing reviews and complaint investigations.⁠¹³ CMS presumes a setting is institutional if it shares a building with a nursing home, hospital or human development center, sits on or next to the grounds of a public institution, or isolates residents. Such settings need heightened scrutiny before waiver funding.⁠¹³ If you plan to rely on Medicaid, avoid putting a new Level II wing inside or next to a nursing home. Providers that stay out of compliance risk losing Living Choices funding.⁠¹³

Sources

1. 1
   Arkansas Department of Human Services, Division of Provider Services and Quality Assurance, Rules for Assisted Living Facilities Level I (R. 01/01/2024) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Arkansas Department of Human Services, Division of Provider Services and Quality Assurance, Rules for Assisted Living Facilities Level II (R. 01/01/2024) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Code of Arkansas Rules, Health Services Permit Agency, 20 CAR §§ 255-201 to 255-206 (Assisted Living Methodology) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Code of Arkansas Rules, Health Services Permit Agency, 20 CAR § 255-105 (Procedures for review) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Code of Arkansas Rules, Health Services Permit Agency, 20 CAR § 255-106 (Continuing effect of a permit of approval) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Code of Arkansas Rules, Health Services Permit Agency, 20 CAR § 255-103 (Scope of review) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Arkansas Department of Health, Arkansas Health Services Permit Agency Checked 12 Oct 2026 · Back to text ↑
8. 8
   Arkansas Health Services Permit Agency, Assisted Living Facility Application Form (Permit of Approval) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Arkansas Health Services Permit Agency, Health Care Facilities and Services Need: Bed Need Book (October 2026) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Arkansas Department of Human Services, DPSQA, Information for Providers (Licensing a Facility) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Arkansas Department of Human Services, DPSQA, Office of Community Services Checked 12 Oct 2026 · Back to text ↑
12. 12
    Arkansas Department of Human Services, Living Choices Assisted Living Waiver Renewal (provider manual packet) Checked 12 Oct 2026 · Back to text ↑
13. 13
    Arkansas Department of Human Services, DPSQA, FAQ on HCBS Settings Requirements, Living Choices Waiver Providers (updated August 15, 2025) Checked 12 Oct 2026 · Back to text ↑

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