Adult Day Care Regulations in Arkansas

Who regulates adult day care in Arkansas

The Arkansas Department of Human Services (DHS) licenses adult day programs through the Office of Long-Term Care, which sits in the Division of Provider Services and Quality Assurance (DPSQA). Both adult day care and adult day health care need a license.

The standards are in the Code of Arkansas Rules, which took effect online January 1, 2025: 20 CAR Part 408, Rules for Adult Day Care Providers, and 20 CAR Part 409 for adult day health care. Medicaid coverage runs through the ARChoices in Homecare waiver, operated by the DHS Division of Aging, Adult and Behavioral Health Services.

Types of adult day programs in Arkansas

• Adult day care (ADC): care and supervision for four or more functionally impaired adults for more than two but less than 24 hours a day, outside the adult's own home.
• Adult day health care (ADHC): organized and continuing supportive health and social services and activities for four or more functionally impaired adults, with the same hour thresholds. ADHC programs need a full-time health care coordinator licensed in Arkansas.

Both types are licensed by the Office of Long-Term Care, and each license states the maximum number of client slots.

How to get licensed in Arkansas

An adult day care facility may not operate without a license from DHS. Based on the rules and the DHS application form, the process looks like this:

1. Complete the Application for License (Form DMS-744, dated January 2013 on the copy we found), which covers adult day care and adult day health care, and confirm with the Office of Long Term Care whether it now takes applications through the DHS online licensing system.
2. Attach the items required by 20 CAR 408-203: building plans with exact dimensions and labeled rooms, hallways, windows and exits; a zoning compliance letter; letters from a licensed electrician and a licensed plumber; and a health approval letter if you use a well or septic tank.
3. DHS verifies that the facility complies with and can meet the standards before issuing the initial license, which takes effect on the date the Office of Long-Term Care sets.
4. Display the license where visitors can see it and stay within your licensed slots.

Licenses run from July 1 to June 30. They cannot be transferred, and a change of ownership requires initial licensure. Separate premises need separate licenses, and a name change needs prior written approval.

Key requirements

• Adult day care staffing: at least two staff when 2 to 16 clients are present, plus one more staff person for each additional eight clients. Nondirect care staff such as secretaries do not count (20 CAR 408-303).
• Adult day health care staffing: one paid full-time direct care position for every five clients, plus a full-time health care coordinator licensed in Arkansas. An LPN may serve as coordinator if supervised by an RN (20 CAR 409-303).
• Director: facilities licensed for more than 15 clients need a full-time director at least 21 years old. Adult day care directors also need at least one year of human services experience.
• Screening: before hiring, check the Employment Clearance Registry and the Adult and Long-Term Care Facility Resident Maltreatment Central Registry, recheck every five years, and complete criminal background checks.
• Training: direct care staff need at least four hours of in-service training per quarter, or 16 hours a year.
• Space: adult day care requires 40 square feet per participant, not counting offices, bathrooms, storage or dining rooms unless the dining room is also used for activities (20 CAR 408-601).

Medicaid funding for adult day in Arkansas

Arkansas Medicaid covers adult day services and adult day health through ARChoices in Homecare, a 1915(c) home and community-based services waiver. The Division of Aging, Adult and Behavioral Health Services operates it under the administrative authority of the Division of Medical Services.

ARChoices serves people 65 and older and adults 21 to 64 with a physical disability who meet financial criteria and the nursing home level of care. The waiver describes adult day services as a group program of care and supervision for four or more participants, and adult day health as services such as rehabilitative, pharmaceutical supervision, therapeutic, health and social services.

Billing basics

ARChoices services must be included in the participant's person-centered service plan. A December 2019 DHS ARChoices training says an individual services budget caps the total dollar amount of waiver services; confirm this in the current waiver. Claim format and procedure codes were not confirmed in a current official fee schedule for this guide, so check current DHS billing guidance.

Arkansas's electronic visit verification rule applies to in-home personal care, attendant care and respite services, including under ARChoices, when delivered in the beneficiary's home. It does not mention adult day services.

Other ways centers are paid

Enrolled veterans who meet VA eligibility and clinical criteria can get Adult Day Health Care through the VA, which may be provided at VA medical centers, State Veterans Homes or community organizations.

Official resources

• 20 CAR Part 408: Rules for Adult Day Care Providers
• 20 CAR Part 409: Adult Day Health Care Rules
• Office of Long Term Care License Application (DMS-744)
• DPSQA: How to Become a Provider
• ARChoices in Homecare Waiver
• Arkansas Medicaid EVV Rule

Frequently asked questions

Do I need a license to open an adult day center in Arkansas?

Yes. Adult day care and adult day health care programs serving four or more functionally impaired adults for more than two hours a day must be licensed by the DHS Office of Long-Term Care before operating.

Does Arkansas Medicaid pay for adult day care?

Yes. The ARChoices in Homecare waiver covers adult day services and adult day health for eligible adults who meet the nursing home level of care, based on their person-centered service plan.

Who inspects adult day centers in Arkansas?

The Office of Long-Term Care, part of the DHS Division of Provider Services and Quality Assurance, licenses centers and verifies that a facility complies with the standards before issuing an initial license.

Is social adult day care regulated in Arkansas?

Yes. Social adult day care is licensed as adult day care under 20 CAR Part 408, with its own staffing, training and space rules.