Arkansas home health agency license: the Permit of Approval, Class A or B, and 2026 limits
To open a home health agency in Arkansas you first need a Permit of Approval (POA) from the Health Services Permit Agency. Only then can you apply to the Department of Health, Health Facility Services, for a Class A license (Medicare-certified) or a Class B license. Need is capped county by county, and the October 2026 Bed Need Book shows room for a new agency in only two of the 75 counties.
Contents13 sections
Key takeaways
- You may not apply for a license until you hold a Permit of Approval. Your license and offices are then limited to the POA area, plus up to 100 miles from the parent or branch office.1
- The October 2026 Bed Need Book counts 427 agencies serving whole counties, against 208 allowed under the need formula. Only Phillips and Union counties show a net need of one agency. Everywhere else you would have to prove that existing agencies are not meeting the need.1410
- POA applications are accepted only on February 1, May 1, August 1 and November 1. Each one costs $3,000 (as published on 2026-10-12), and the agency then has 90 days from completeness to decide.68
- A Class A license is issued only to Medicare-certified agencies, and Arkansas Medicaid home health requires both Class A and Medicare certification. The CMS freeze on new Medicare home health enrollments, in effect since May 13, 2026, therefore blocks both payers for new agencies.11615
- Home health aides need at least 75 training hours and personal care aides at least 40. In both cases the training must be approved by the Department of Health.1
Quick facts
| Permit | Permit of Approval, Arkansas Health Services Permit Agency (906 Broadway, Suite 200, Little Rock; 501-661-2509) |
|---|---|
| License | Arkansas Department of Health, Health Facility Services (5800 W. 10th St., Suite 400, Little Rock; 501-661-2201) |
| Rules | Rules for Home Health Agencies in Arkansas (20 CAR Pt. 46), revision effective June 17, 2024; POA rules at 20 CAR Pt. 255 |
| POA fee | $3,000 per review (as published on 2026-10-12) |
| POA filing dates | Feb 1, May 1, Aug 1, Nov 1 only |
| License term | Calendar year, expires December 31 |
| Medicare | New enrollments frozen nationwide since May 13, 2026 |
Fees and county need figures were checked October 12, 2026. The Bed Need Book is updated periodically; the October 2026 edition is dated September 30, 2026.
Arkansas controls the number of home health agencies, not only their quality. Two state bodies are involved. The Arkansas Health Services Permit Agency, overseen by a nine-member Health Services Permit Commission, decides whether a county needs another agency and issues a Permit of Approval (POA).5 The Arkansas Department of Health’s Health Facility Services section then licenses the agency, inspects it, and acts as the CMS state survey agency for Medicare certification.3 The rule sets the order: “Prior to applying for a license an agency shall obtain a Permit of Approval (POA).”1
Who needs this license, and who does not
The licensing rule defines a home health agency as any person or organization, public or private, for-profit or nonprofit, “that provides a home health service for pay or other consideration in a patient’s residence.”1 “Residence” is broad. It includes a nursing home, residential care facility or convalescent home as well as a private house, so sending nurses into a facility counts.1
A license is required if you supply people to provide any of these eight services in someone’s home: skilled nursing, physical therapy, occupational therapy, speech-language pathology, medical social work, home health aide services, personal care aide services, or extended care.1 Because personal care aide services are on that list, a non-medical agency can fall under this license. The neighboring license for Medicaid personal and attendant care is the Department of Health’s private care agency license; see the Arkansas private care agency guide.
The rule (following Ark. Code § 20-10-802) exempts, among others:1
- physicians, dentists, RNs and physical therapists whose home visits are incidental to their private office practice;
- RNs, LVNs, PTs, OTs, speech therapists and medical social workers working as sole practitioners;
- nonprofit professional registries that only connect consumers with practitioners and neither keep patient records nor direct care;
- someone whose permanent residence is the patient’s residence;
- employees of a licensed agency who are paid only wages;
- a nursing home or other institution serving only its own residents, and hospitals serving only inpatients;
- a person providing one health service under contract with a licensed agency;
- durable medical equipment suppliers, and pharmacies supplying drugs and supplies;
- religious nursing services for people who rely on prayer for healing;
- providers serving people with developmental disabilities under a DHS Division of Developmental Disabilities Services license or certificate.
Claims of exemption go to Health Facility Services in writing, with supporting documentation.1 Two more exemptions are pending; see the last section.
Step one: the Permit of Approval and the county cap
The Permit Agency reviews new home health agencies, expanded service areas, and moves from a Class B to a Class A license against a population formula. The service area is a county.1013
| County population | Agencies allowed |
|---|---|
| Up to 30,000 | 2 |
| 30,000 to 50,000 | 3 |
| 50,000 to 75,000 | 4 |
| 75,000 to 110,000 | 5 |
| 110,000 to 150,000 | 6 |
| 150,000 to 250,000 | 7 |
| 250,000 to 400,000 | 8 |
| 400,000 and over | 1 per 50,000 people |
The rule’s stated reasoning is that denser areas can be served with fewer staff because travel time is shorter.10 An applicant may still be approved where the formula shows no need, but only with documentation “that existing agencies are not meeting the needs of the service area population.”10 The application form puts the burden of proof on the applicant.13
What the October 2026 numbers show
The Permit Agency’s October 2026 Bed Need Book (updated September 30, 2026) applies the formula to 2031 population projections. Statewide it counts 427 licensed agencies serving entire counties, against 208 allowed: a net need of minus 219.14 Only two counties show a positive need, of one agency each:14
| County | Projected 2031 population | Agencies serving entire county | Agencies allowed | Net need |
|---|---|---|---|---|
| Phillips | 11,644 | 1 | 2 | +1 |
| Union | 34,810 | 2 | 3 | +1 |
| Arkansas | 14,698 | 2 | 2 | 0 |
| Columbia | 20,586 | 2 | 2 | 0 |
| Jefferson | 57,693 | 4 | 4 | 0 |
| Miller | 40,544 | 3 | 3 | 0 |
| White | 80,944 | 5 | 5 | 0 |
Scroll the table sideways to see every column.
The large markets are already over the cap. Pulaski has 9 agencies against 8 allowed, Saline 13 against 6, and Benton 9 against 8.14 The form tells you that if your county’s net need is zero or below, “there is no need for Home Health Services and you will have to apply under the exception.”13
Three other rules narrow the field further:
- Clean survey history. No application for a new agency, expanded area or change of license class will be approved if the applicant had any condition-level deficiencies in the previous 36 months.11
- Small rural hospitals. A short-term acute hospital with 50 or fewer licensed beds, in a county of 25,000 people or fewer at the last census, may be approved for an agency serving its county or the townships within 20 miles. That agency must be licensed within 24 months of approval.12
- Buying instead of building. The POA rules say acquiring an existing health facility does not require a permit of approval. Separately, a permit “is not transferable to any other institution or party without approval of the commission,” and the POA form says transfers must include at least $2,500 of assets.7913 Confirm with both agencies how an acquisition will be handled before you sign.
Preparing the POA application
The Permit Agency recommends a pre-submission conference with its staff, by appointment. You file one original, signed in blue ink, and one copy, with the $3,000 review fee (as published on 2026-10-12). Do not use binders or folders.6813 The home health form (revision dated 8/10/2020) asks for:13
Basic information
The proposed agency, the county or counties to be served, whether you want a Class A or Class B license, the ownership type, the parent organization and a project contact.
Project description
Your services, including the “core home health services”, any services provided by contractors (with proof of each contractor’s capability), and a start date.
Need
Your county’s figures from the Bed Need Book, an exception argument if net need is zero or below, the benefit to the local health system, and at least one letter of support from a practicing physician in the community who will agree to refer patients.
Staffing
Personnel by classification with proposed salaries, a time-phased hiring plan, and your recruitment and retention plan.
Feasibility
Estimated start-up and annual operating costs. You must prove the money is there. The form accepts a pre-approved loan from a financial institution for the total project amount, or, for individual investors or partners, proof of a bank deposit for the amount needed, and either document can be no more than 90 days old. Existing agencies use documentation signed by an outside CPA.
Attachments
Detailed budget projections broken out by payer and discipline, and cost-per-visit projections.
Cost containment
How the project will reduce health care costs and save state and federal money.
The application cannot change much after filing. You may correct a mistake only within the first 30 days of review, under conditions set in the rule.8
The review calendar
| Submit by 4:30 p.m. on | Placed under review by | Agency decision by |
|---|---|---|
| February 1 | March 1 | May 30 |
| May 1 | June 1 | August 30 |
| August 1 | September 1 | November 30 |
| November 1 | December 1 | February 28 |
The agency has 30 days to decide whether the application is complete, and may allow up to 15 more days for missing information.8 Public notice runs in a newspaper of general circulation. Existing agencies and other opponents then have 30 days to file written opposition, which also preserves their right to appeal.8 By statute (Ark. Code § 20-8-104) the decision is due within 90 days of the application being deemed complete.8 An applicant or opponent may appeal to the Commission within 30 days of receiving the decision. The Commission is to hold a hearing within 90 days of the agency decision and decide within 15 days after it closes.68
Once you have a permit, a home health project that needs no construction must be licensed within one year of the POA date. The Commission may grant extensions for good cause, no more than six months at a time.913
Class A, Class B and the three service categories
Health Facility Services issues one of two classes:1
- Class A: the agency is certified for Medicare (Title XVIII) and meets the federal Conditions of Participation.
- Class B: the agency provides home health services but is not Medicare-certified.
A Class A holder may add a derivative Class B license without a separate POA. That license cannot be split from the Class A license or extended beyond the Class A service area.1 Moving from Class B to Class A requires a new POA under the need standard.10
Each license also states which categories you may provide, and each category brings in different sections of the rule:1
| Category | Rule sections that apply |
|---|---|
| Intermittent skilled care | General requirements + skilled care standards |
| Extended care (six or more hours of continuous service in 24 hours, skilled nursing plus other services; Medicaid Personal Care excluded) | General + skilled + extended care standards |
| Personal care | General + personal care standards |
To add a category, notify Health Facility Services. It will ask for the information it needs and change the license if you qualify. To drop a category, notify the section and explain how patients will be transferred.1
Applying to Health Facility Services
You ask Health Facility Services for a New Provider Packet by mail, email or fax. The same packet starts both state licensure and Medicare certification for home health agencies.4 Contact: Health Facility Services, 5800 W. 10th St., Suite 400, Little Rock, AR 72204; 501-661-2201 or 1-800-223-0340; [email protected].34
You need a “licensed fully operational physical location” in Arkansas, inside the geographic area named in your POA.1 A review or inspection takes place before the license is issued.1
The Rules for Home Health Agencies do not state a license fee, and the Department of Health’s Health Facility Services pages do not publish one; the New Provider Packet is sent only on request.134 Ask Health Facility Services for the current license fee and any survey or Medicare-certification charges when you request the packet, and budget for the $3,000 POA review fee separately.
People the rule requires
- Governing board. At least one member, who may be the owner. The board is legally responsible for the agency. It approves the quality assurance plan, bylaws and clinical policies, appoints an administrator who is an employee, approves a plan for an alternate, and oversees finances.1
- Administrator. An agency employee who is a physician, a registered nurse, or someone with at least one year of supervisory or administrative experience in home health or a related health program. The administrator runs daily operations, hires and supervises staff, keeps public information accurate, runs the budget and accounting system, and makes sure an alternate is in place.1
- Clinical manager. A licensed physician, PT, speech-language pathologist, OT, audiologist, social worker or RN.1
- Supervisors of aides. Either a skilled professional or someone with two years of full-time higher education. A person with a high school diploma or GED may substitute one year of full-time supervisory work in a health facility or community agency for each year of college.1
- Background checks. Each personnel file must include criminal history checks under Ark. Code § 20-38-101 et seq.1
Aide training
| Home health aide | Personal care aide | |
|---|---|---|
| Minimum hours | 75, including at least 16 classroom hours before at least 16 hours of supervised practical training | 40, classroom and clinical, related to the home setting |
| Supervision | Under an RN | Supervised by an RN |
| Content | Table 2 of the rule; RN observes the aide performing listed skills (vital signs, bathing, transfers, range of motion and others) | Table 1 of the rule, with written objectives, outcomes and evaluation methods |
| Supervisory home visits | Every 14 days | Every 60 days |
| In-service | 12 hours per 12 months | 12 hours per 12 months |
The Department must approve all aide training. Unless you are authorized to operate a school, you may train only your own employees.1
Operating standards surveyors will look for
The rule requires written policies, reviewed every year, covering: an organizational chart down to the patient level; services and hours; admission, referral, transfer and discharge criteria; an annual operating budget approved by the board or administrator; staff orientation; personnel policies; procedures for every task; an infection control program that follows CDC TB guidance; an agency-wide quality assurance and improvement program, including client satisfaction surveys; and a complaint and incident log.1 You must give every patient a written bill of rights, which includes the State Home Health Hotline number. You also need advance directive policies, explained at the first evaluation visit.1 You must post the Department’s notice that attacking a healthcare worker is a felony (Ark. Code § 5-13-202) at public entrances and patient waiting areas.1
For skilled care, Arkansas sets these clocks:1
- initial assessment within 48 hours of referral or discharge, by an RN if nursing is provided;
- reassessment and plan-of-care revision at least every 60 days;
- physician, podiatrist or licensed practitioner signatures on plans and verbal orders within 30 days;
- case conferences on every patient at least every two months;
- clinical notes written the day of service and filed in the record at least every 14 days.
If you cannot provide a referred service right away, you must tell the referral source and admit the patient only if no other licensed agency in the area has the service available.1 If you offer after-hours coverage, an RN must be available. Extended care requires 24-hour coverage, and an LPN may take the first call.1 For skilled extended care, an RN employee visits at least every two weeks, or monthly once a case lasting over three months is classed as chronic or stabilized. Aide-only extended care needs an RN visit every 30 days. Before withdrawing skilled nursing from an extended care patient, you must show recruitment efforts and give 60 days’ written notice.1 For personal care, an aide service plan sets the delegated tasks, and supervision happens at least once a year.1
Medicare and Medicaid in 2026
On May 13, 2026, CMS imposed a six-month nationwide moratorium on Medicare enrollment of new home health agencies, branches and practice locations. Applications the Medicare contractor received before that date are not affected. A change of ownership that would require initial enrollment is covered, and CMS may extend the moratorium in six-month increments.15 Health Facility Services and the Permit Agency both posted the notice.35
In Arkansas this matters for more than Medicare. The state Medicaid home health program enrolls only agencies that hold a Class A license and current Medicare certification.16 Class A is itself reserved for Medicare-certified agencies.1 While the moratorium lasts, a new agency’s practical route is a Class B license serving private-pay and other non-Medicare patients. For planning, note that Arkansas Medicaid caps home health at 50 visits per beneficiary per state fiscal year (July 1 to June 30), counting RN, LPN and aide visits together.16
When Medicare enrollment reopens, federal rules require a new home health agency to hold “initial reserve operating funds”. These must cover its first three months after billing privileges are granted, not counting Medicare receivables, and must be available from the day it applies.17
Branches, service area and out-of-area emergencies
You may serve within your POA area and up to 100 miles from the parent or branch office.1 To open a branch, notify Health Facility Services in advance on Form HHA-001. Describe the services, the area, and exactly how the parent agency will supervise the branch. The parent keeps control of governance, contracts, quality improvement, policies, staffing, human resources, closed records and training. Branches are surveyed.1 Expanding an existing service area also requires a POA.7
For a patient outside your area who needs specialized nursing that no licensed local agency can provide, Health Facility Services may approve conditional emergency service. First you document that you contacted every agency licensed for extended care in the patient’s area. An agency that does not answer within 24 hours counts as unable to help. Approvals last 180 days and must be renewed with fresh documentation. At each renewal the patient must be offered a transfer if a local agency has become available.1
Renewal, inspections and enforcement
Licenses run on the calendar year and expire December 31. You renew on Department forms.1 After the initial inspection, the Department inspects at least every three years. When an inspection finds deficiencies, you have 60 days to correct them, and the Department follows up on site or by mail.1 You must notify Health Facility Services of changes in name, location, services, license class, Medicare status, contact details or ownership. If you close, send written notice of the date, the patient transfer plan and the records storage plan, and return the original license.1
The Department may deny, suspend or revoke a license for rule violations, a material misstatement, deceptive practices, altering a license, or acts that materially affect patient safety. You have 30 days after notice to request a hearing in writing. An emergency suspension takes effect immediately, with a hearing within seven days.1 Separately, a POA is lost if the agency is not licensed within the deadline and no extension has been granted.9
Rule changes pending in 2026
The Department of Health has proposed amendments to the home health rule, now codified as 20 CAR Part 46, to carry out three 2025 laws. Act 144 adds an exemption for licensed PACE providers serving enrolled participants. Act 849 adds an exemption for entities that provide only therapy not reimbursed under Medicare Part A, by licensed PTs, OTs or speech-language pathologists. Act 643 lets a home caregiver who already completed the required training, and can document it, skip repeating it.182 Public comment ran from July 5 to August 4, 2026.19 The Department’s pages checked on October 12, 2026 show the proposal and the comment notice but no adoption order or effective date, so the June 17, 2024 revision remains the rule text this guide relies on.1219 Ask Health Facility Services whether the amendments have been adopted before you rely on either exemption.
A companion proposal amends the criminal background check rules for home health, hospice and private care agencies. Under Acts 674 and 853 of 2025 it allows third-party evaluation services to run the checks, counts independent contractors as employees, and moves the process online.20
Other Arkansas care licenses that also go through the Permit Agency are explained in the guides to assisted living facilities and residential care facilities. Daytime programs are covered in the adult day care guide.
Sources
- 1
- 2
- 3 Arkansas Department of Health, Health Facility Services Checked 12 Oct 2026 · Back to text ↑
- 4
- 5 Arkansas Department of Health, Arkansas Health Services Permit Agency Checked 12 Oct 2026 · Back to text ↑
- 6 Arkansas Health Services Permit Agency, Permit of Approval Process Checked 12 Oct 2026 · Back to text ↑
- 7 Code of Arkansas Rules, 20 CAR § 255-103, Scope of review Checked 12 Oct 2026 · Back to text ↑
- 8 Code of Arkansas Rules, 20 CAR § 255-105, Procedures for review Checked 12 Oct 2026 · Back to text ↑
- 9
- 10 Code of Arkansas Rules, 20 CAR § 255-301, Home health methodology Checked 12 Oct 2026 · Back to text ↑
- 11 Code of Arkansas Rules, 20 CAR § 255-302, Unfavorable review Checked 12 Oct 2026 · Back to text ↑
- 12 Code of Arkansas Rules, 20 CAR § 255-303, Rural hospitals Checked 12 Oct 2026 · Back to text ↑
- 13
- 14
- 15
- 16
- 17 eCFR, 42 CFR 489.28, Special capitalization requirements for HHAs Checked 12 Oct 2026 · Back to text ↑
- 18
- 19 Arkansas Department of Health, Notice of public comment period, 20 CAR Pt. 46 Checked 12 Oct 2026 · Back to text ↑
- 20
Was this information accurate? Report an error
Related guides
- Arkansas private care agency license: the Medicaid personal care route to in-home careArkansas · Non-medical home care agency
- Arkansas assisted living facility license: Permit of Approval, Level I and Level IIArkansas · Assisted living facility
- Arkansas residential care facility license: the 2005 bed moratorium and the buy-in routeArkansas · Small residential care home
- Arkansas adult day care license: DPSQA rules, slots, staffing and the Act 905 questionArkansas · Adult day care
Arkansas and neighboring states
Compare all 51| State | License | Who needs it | State fee |
|---|---|---|---|
| Arkansas (this guide) | Home Health Agency license | Providing home health services for pay in a patient's home; Permit required | $3,000 per review |
| Missouri | Home Health Agency license | Offers 2+ home health services incl. nursing, from a non-home office | $600 initial, $600 each year at renewal, $600 on change of ownership |
| Tennessee | Home Care Organization Providing Home Health Services license | Own nurses or therapists in homes; certificate of need required | $2.25 per $1,000 of project cost, $3,000 minimum, $45,000 maximum |
| Mississippi | Home Health Agency license | Skilled home services; needs a certificate of need (moratorium) | 0.25% of the capital expenditure, $2,500 minimum, $12,500 maximum |
| Louisiana | Home Health Agency (HHA) License | Own nurses, therapists or aides in clients' homes; licensed | $600 initial, $600 annual renewal, $600 CHOW, $300 per branch |
| Texas | Home and Community Support Services Agency (HCSSA) license, Licensed Home Health or Licensed and Certified Home Health category | Sending nurses or therapists into clients' homes | $2,625 per parent or branch office, initial or three-year renewal |
| Oklahoma | Home Care Agency license | Any organization giving skilled or personal care in clients' homes for a fee | $1,000 initial application; $500 annual renewal; $25 per branch |
Shortened from each state's guide and our 51-state table, as of each guide's last review. Fees are the state's own; local permits and background checks cost extra.