NURSING FACILITY (NF) PROVIDER IN ARIZONA

Fatumata Kaba
6 days ago
4 min read

DELIVERING SKILLED, LONG-TERM CARE SERVICES FOR INDIVIDUALS WITH COMPLEX MEDICAL NEEDS

Nursing Facility (NF) Services in Arizona provide 24-hour skilled nursing care, rehabilitation, and assistance with daily living activities for individuals who have complex health conditions and require a higher level of care than can be provided in home or community settings. These services are authorized under Arizona’s Medicaid Long-Term Care system and are designed to support individuals who meet nursing facility level-of-care criteria.

1. GOVERNING AGENCIES

Agency: Arizona Department of Health Services (ADHS) – Division of Licensing Services

Role: Licenses Nursing Facilities and ensures compliance with state health and safety standards

Agency: Arizona Health Care Cost Containment System (AHCCCS)

Role: Manages Medicaid enrollment, reimbursement, and oversight for Nursing Facility services

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight of Medicaid and Medicare certification for Nursing Facilities and ensures compliance with federal regulations

2. NURSING FACILITY SERVICE OVERVIEW

Nursing Facilities offer long-term residential care with access to professional medical and personal support services, available 24/7.

Approved providers may deliver:

Skilled nursing care (RN or LPN services)
Administration of prescribed medications and treatments
Physical, occupational, and speech therapy services
Health monitoring and chronic disease management
Assistance with Activities of Daily Living (ADLs) such as bathing, toileting, eating, and mobility
Nutritional services, meal planning, and therapeutic diets
Social services coordination and discharge planning
Recreational and therapeutic activities
Hospice coordination services if needed

All services must be delivered according to individualized care plans and in compliance with Medicaid and Medicare standards.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business entity with the Arizona Corporation Commission
Obtain EIN from the IRS and NPI (Type 2)
Obtain a Nursing Care Institution License from ADHS
Meet CMS certification requirements (for facilities seeking Medicaid and Medicare reimbursement)
Maintain liability insurance and meet minimum staffing ratio requirements
Develop comprehensive policies for nursing services, emergency preparedness, infection control, and resident rights

4. AHCCCS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Request Medicaid Nursing Facility enrollment packet from AHCCCS
Attend any required AHCCCS or Managed Care Organization (MCO) training sessions

Application and Documentation Submission:

Submit proof of licensure, staffing plans, facility operating procedures, and CMS survey results (if certified)
Provide sample resident service agreements, emergency procedures, and care plans
Submit staff credentialing documentation, background checks, and insurance policies

Program Readiness Review:

AHCCCS and/or MCOs review facility readiness, staffing qualifications, service delivery models, and compliance with care standards
Facility inspections and audits may be conducted before final approval

Approval & Medicaid Enrollment:

After approval, contract with AHCCCS and/or Medicaid Managed Care Organizations serving ALTCS members
Finalize billing setup and Medicaid claims system configuration

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License
IRS EIN confirmation
NPI confirmation
Nursing Care Institution License from ADHS
CMS Certification of Participation (if applicable)
Liability insurance coverage documentation
Policy & Procedure Manual including:
- Admission and discharge processes
- Person-centered care planning protocols
- Medication administration and skilled nursing service procedures
- Resident rights and grievance resolution processes
- Emergency preparedness and fire safety protocols
- Staff background checks, training records, and annual competency reviews
- Incident reporting, infection control, and quality assurance programs
- Medicaid and Medicare billing, documentation, and authorization tracking systems

6. STAFFING REQUIREMENTS

Role: Nursing Facility Administrator

Requirements: Active Arizona Nursing Care Institution Administrator License, background check clearance, experience managing long-term care operations

Role: Director of Nursing (DON)

Requirements: Active Arizona Registered Nurse (RN) license, supervisory experience in skilled nursing facilities

Role: Licensed Nurses (RNs/LPNs) and Certified Nursing Assistants (CNAs)

Requirements: Arizona licensure/certification, CPR certification, and background check clearance

All staff must complete:

Initial and annual resident rights, abuse prevention, and confidentiality training
Infection control and emergency preparedness training
Clinical skills assessments and ongoing competency evaluations

7. MEDICAID WAIVER SERVICES

While Nursing Facility services fall primarily under the Arizona Long Term Care System (ALTCS) rather than traditional HCBS waivers, services are covered under these programs:

ALTCS – Elderly and Physically Disabled (EPD) Program
ALTCS – Developmental Disabilities (DD) Program (when nursing facility level of care is appropriate)

Approved Nursing Facilities may deliver:

24/7 skilled nursing and personal care services
Therapy services to support rehabilitation and functional improvement
Care coordination with ALTCS case managers and medical teams
Transitional care planning when residents can return to less restrictive settings

8. TIMELINE TO LAUNCH

Phase: Business Formation and Licensing Setup

Timeline: 2–4 weeks

Phase: Facility Readiness and CMS Certification Survey (if seeking certification)

Timeline: 90–180 days

Phase: Staff Hiring, Training, and Facility Systems Setup

Timeline: 60–90 days

Phase: AHCCCS Enrollment and MCO Contracting

Timeline: 60–90 days

9. CONTACT INFORMATION

Arizona Department of Health Services – Division of Licensing Services

Website: https://www.azdhs.gov/licensing/

Arizona Health Care Cost Containment System (AHCCCS)

Website: https://www.azahcccs.gov/

Arizona Medicaid Provider Enrollment Portal

Website: https://www.azahcccs.gov/PlansProviders/NewProviders/

Centers for Medicare & Medicaid Services (CMS) Nursing Home Provider Enrollment

Website: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/NHs

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — ARIZONA NURSING FACILITY PROVIDER

WCG supports healthcare entrepreneurs and facility owners in establishing Medicaid- and Medicare-compliant Nursing Facilities under Arizona’s ALTCS program.

Scope of Work: