Arizona - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Arizona Department of Health Services (ADHS) Bureau of Medical Facilities Licensing issues Home Health Agency (HHA) licenses under Arizona Administrative Code (A.A.C.) Title 9, Chapter 10, Article 12, allowing agencies to deliver intermittent skilled nursing and therapy. Funding for these services flows primarily through the Arizona Health Care Cost Containment System (AHCCCS) and its Arizona Long Term Care System (ALTCS) managed care plans.

Approval requires securing the ADHS license via the Licensing Management System (LMS) and subsequently enrolling as an institutional provider in the AHCCCS Provider Enrollment Portal (APEP). Applicants must secure Medicare certification to bill for dual-eligible members and must successfully contract with regional ALTCS Managed Care Organizations (MCOs) to receive patient referrals and authorizations.

1. Service Definition and Scope

In Arizona, Home Health Services consist of intermittent skilled nursing, physical therapy, occupational therapy, and speech therapy provided in a patient's place of residence. These services are designed to treat an illness or injury, aiming to restore the patient's health and independence.

All care must be delivered under a physician-ordered plan of care that is regularly reviewed. The service scope also includes home health aide services, provided they are supervised by a registered nurse or licensed therapist.

• Service Location: Patient's private residence or independent living environment.
• Skilled Nursing: Provided by an Arizona Board of Nursing licensed RN or LPN under RN supervision.
• Therapy Services: Physical, occupational, and speech therapy delivered by Arizona-licensed therapists.
• Plan of Care: Must be ordered, established, and periodically reviewed by a licensed physician, nurse practitioner, or physician assistant.
• Home Health Aide: Unlicensed assistive personnel providing personal care and basic health-related tasks under RN supervision.

2. Regulatory and Oversight Agencies

The Arizona Department of Health Services (ADHS) is the primary regulatory body responsible for licensing and surveying Home Health Agencies. They ensure compliance with state health and safety codes.

The Arizona Health Care Cost Containment System (AHCCCS) manages Medicaid enrollment and oversees the managed care plans that administer the ALTCS program.

• Licensing Authority: Arizona Department of Health Services (ADHS) Bureau of Medical Facilities Licensing (https://www.azdhs.gov/licensing/index.php)
• Medicaid Authority: Arizona Health Care Cost Containment System (AHCCCS) (https://www.azahcccs.gov)
• Enrollment Portal: AHCCCS Provider Enrollment Portal (APEP) (https://www.azahcccs.gov/APEP)
• Background Checks: Arizona Department of Public Safety (DPS) Fingerprint Clearance Card system (https://www.azdps.gov/services/public/fingerprint)

3. Gatekeeping Prerequisites: Who Can Even Apply

Arizona does not utilize a Certificate of Need (CON) program for Home Health Agencies, meaning there are no state-mandated market need reviews prior to licensure. However, structural prerequisites exist for Medicaid participation.

To operate viably within the AHCCCS system, agencies must navigate managed care contracting and federal certification requirements.

• Certificate of Need: Arizona does not require a Certificate of Need (CON) for Home Health Agencies.
• Medicare Certification: Required by AHCCCS for agencies serving dual-eligible members to ensure Medicare is billed as the primary payer before Medicaid.
• Managed Care Contracting: Providers must secure contracts with regional ALTCS Managed Care Organizations (e.g., Mercy Care, Banner University Family Care) to receive Medicaid authorizations and referrals.
• Application Fee: AHCCCS requires a $750 institutional provider enrollment fee (for calendar year 2026) prior to APEP approval.

4. Licensure and Certification Requirements

Prospective Home Health Agencies must apply for licensure through the ADHS Licensing Management System (LMS). Paper applications are no longer accepted.

The agency must demonstrate compliance with A.A.C. Title 9, Chapter 10, Article 12, which dictates administrative structure, personnel qualifications, and physical plant standards.

• Application Portal: ADHS Licensing Management System (LMS) is mandatory for all new applications and renewals.
• Statutory Authority: Arizona Administrative Code (A.A.C.) Title 9, Chapter 10, Article 12.
• Administrator Qualifications: Must be a physician, RN, or individual with at least one year of supervisory or administrative experience in health care.
• Director of Nursing: Must be an Arizona-licensed RN with at least one year of experience as a registered nurse.
• Initial Survey: ADHS conducts an on-site licensing survey to verify operational readiness before issuing the license.

5. Medicaid Provider Enrollment

Once licensed by ADHS, the agency must enroll as a Medicaid provider using the AHCCCS Provider Enrollment Portal (APEP).

Enrollment requires submission of federal tax documents, banking information for electronic funds transfer, and payment of the institutional application fee.

• System: AHCCCS Provider Enrollment Portal (APEP).
• NPI Requirement: Must obtain a Type 2 National Provider Identifier (NPI) from NPPES.
• Tax Documentation: Completed W-9 form matching the IRS database.
• EFT Authorization: Electronic Funds Transfer form submitted via the AHCCCS Solutions Center with a voided check or bank letter.
• Revalidation: Providers must revalidate their AHCCCS enrollment every four years.

6. Staffing, Training and Background Checks

Arizona mandates strict background check requirements for all personnel providing direct patient care. The primary mechanism is the Fingerprint Clearance Card.

Clinical staff must hold active, unencumbered licenses, and aides must complete state-approved training programs.

• Background Check: Level 1 Fingerprint Clearance Card (FCC) issued by the Arizona Department of Public Safety (DPS) is required for all patient-facing staff.
• Nursing Licensure: Active, unencumbered RN or LPN license from the Arizona State Board of Nursing or a recognized compact state.
• Aide Training: Home health aides must complete a state-approved training program and pass a competency evaluation.
• CPR Certification: All clinical staff must maintain current cardiopulmonary resuscitation (CPR) certification.

7. Documentation, Policies and Records

ADHS requires Home Health Agencies to maintain comprehensive written policies governing patient care, rights, and emergency procedures.

Clinical records must be meticulously maintained and retained according to state statutes.

• Patient Rights: Written policy detailing patient rights, grievance procedures, and contact info for ADHS complaints.
• Clinical Records: Must maintain comprehensive medical records for at least six years after the last date of service for adult patients.
• Emergency Preparedness: Documented disaster plan updated annually, including procedures for patient evacuation or sheltering in place.
• Quality Management: Written Quality Management Program (QMP) to track incidents, infections, and improve care delivery.

8. Billing, Rates and Claims

Medicaid in Arizona operates primarily under a managed care model. Therefore, Home Health Agencies bill the contracted ALTCS MCOs rather than the state directly.

AHCCCS acts as the payer of last resort, meaning all other liable parties, including Medicare, must be billed first.

• Payer of Last Resort: Medicaid (AHCCCS) only pays after Medicare or commercial insurance has been exhausted.
• Billing System: Claims are submitted directly to the contracted ALTCS Managed Care Organization, not the state MMIS.
• Prior Authorization: All non-emergency home health visits require prior authorization from the member's MCO.
• Fee Schedule: AHCCCS publishes baseline fee-for-service rates, but actual reimbursement is negotiated in the MCO contract.

9. Approval Sequence and Timeline

The approval process is sequential, beginning with state licensure, followed by federal certification (if applicable), and concluding with Medicaid enrollment and MCO contracting.

The entire process from initial application to billing the first claim can take several months.

• Step 1: Submit ADHS Home Health Agency license application via the LMS portal.
• Step 2: Pass the ADHS initial on-site licensing survey.
• Step 3: Submit Medicare CMS-855A enrollment (if seeking Medicare certification).
• Step 4: Submit AHCCCS enrollment via APEP (AHCCCS generally processes applications within 60 days).
• Step 5: Negotiate and execute contracts with regional ALTCS MCOs.

10. Common Denials and Survey Findings

Applications and surveys frequently face delays or denials due to incomplete documentation or failure to adhere to strict regulatory timelines.

ADHS surveyors focus heavily on clinical documentation and staff credentialing during on-site visits.

• Incomplete APEP Application: Failure to submit the EFT form or pay the $750 fee results in AHCCCS application denial.
• Care Plan Deficiencies: ADHS frequently cites agencies for failing to update the physician's plan of care every 60 days.
• Background Check Lapses: Staff providing care before receiving their DPS Fingerprint Clearance Card.
• Supervision Failures: Lack of documented RN supervisory visits for home health aides every 14 days.

11. Key Contacts and Resources

Providers should utilize official state portals and resources for the most current regulatory updates and application submissions.

The AHCCCS Solutions Center is the primary contact point for enrollment and billing inquiries.

• ADHS Medical Facilities Licensing: https://www.azdhs.gov/licensing/index.php
• AHCCCS Provider Enrollment (APEP): https://www.azahcccs.gov/APEP
• AHCCCS Solutions Center: https://servicenow.azahcccs.gov/gsp
• AZ Care Check (Provider Search): https://azcarecheck.azdhs.gov/s

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