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Arizona - Personal Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Arizona Health Care Cost Containment System (AHCCCS) funds hands-on activities of daily living through the Arizona Long Term Care System (ALTCS) 1115 Waiver, designating these services primarily as Attendant Care (ATC) and Personal Care (PCA). Providers must secure a Qualified Vendor Agreement (QVA) with the Department of Economic Security (DES) Division of Developmental Disabilities (DDD) or execute network contracts with regional ALTCS Managed Care Organizations (MCOs) before AHCCCS will authorize claims for these services.

Operating as an Attendant Care provider requires registering through the AHCCCS Provider Enrollment Portal (APEP) and complying with Arizona's Direct Care Worker (DCW) training and testing standards. Because Arizona utilizes a mandatory managed care delivery system for long-term services and supports, standalone Medicaid enrollment does not grant access to the patient population; providers must successfully navigate the MCO credentialing or DES DDD procurement processes to receive authorizations and payments.

1. Service Definition and Scope

Under the ALTCS program, hands-on assistance with bathing, dressing, toileting, and transferring is categorized primarily as Attendant Care (ATC) and Personal Care (PCA). Attendant Care provides a combination of personal care and homemaking services to enable members to remain in their own homes.

These services are authorized based on a standardized assessment conducted by an ALTCS MCO case manager or DES DDD support coordinator. The scope strictly prohibits the delegation of skilled nursing tasks unless the provider is also licensed as a Home Health Agency and the worker is appropriately certified.

2. Regulatory and Oversight Agencies

The Arizona Health Care Cost Containment System (AHCCCS) serves as the single state Medicaid agency, overseeing all provider enrollment and establishing the overarching policies for the ALTCS program. The Department of Economic Security (DES) Division of Developmental Disabilities (DDD) manages the network of providers serving individuals with intellectual and developmental disabilities.

The Arizona Department of Health Services (ADHS) Bureau of Medical Facilities Licensing handles the licensure of formal Home Health Agencies, though non-medical Attendant Care agencies may operate without this specific facility license if they strictly provide non-medical HCBS and meet AHCCCS/DDD credentialing standards.

3. Gatekeeping Prerequisites: Who Can Even Apply

Arizona's mandatory managed care structure requires providers to secure network contracts with ALTCS MCOs (such as Mercy Care or Banner University Family Care) or obtain a Qualified Vendor Agreement (QVA) from DES DDD. Without these contracts, an agency cannot receive member authorizations or bill for services, rendering AHCCCS enrollment functionally useless on its own.

The DES DDD Qualified Vendor Agreement process operates as an open and continuous procurement, but requires applicants to submit a comprehensive application detailing their business plan, policies, and financial stability. MCO contracting is subject to network adequacy reviews, meaning an MCO can refuse to contract with a new provider if they determine their current network of Attendant Care agencies is sufficient.

4. Licensure and Certification Requirements

Arizona does not issue a distinct "non-medical home care" license. Agencies providing only non-medical Attendant Care and Personal Care are certified directly through their AHCCCS enrollment and subsequent MCO/DDD credentialing. However, if the agency intends to offer any skilled nursing or therapy services alongside personal care, they must obtain a Home Health Agency license from ADHS.

All agencies, regardless of ADHS licensure status, must comply with the AHCCCS Direct Care Worker (DCW) training and testing program requirements. Agencies must either become an Approved Training Program themselves or contract with one to ensure all staff meet the state's competency standards.

5. Medicaid Provider Enrollment

Agencies must enroll through the AHCCCS Provider Enrollment Portal (APEP) to receive an AHCCCS Provider ID. The process requires submitting organizational details, ownership disclosures, and completing the Electronic Funds Transfer (EFT) authorization.

Attendant Care agencies are subject to ACA provider screening requirements. For calendar year 2026, the application enrollment fee is $750, which offsets the cost of conducting the required screening for the provider application.

6. Staffing, Training and Background Checks

All staff providing Attendant Care or Personal Care must complete the AHCCCS Direct Care Worker (DCW) training program, which includes a standardized curriculum and competency testing. The training covers fundamental skills, infection control, and specific modules for aging/physical disabilities or developmental disabilities.

Arizona law mandates strict background screening for anyone providing direct care to vulnerable adults or children. Every direct care worker must obtain and maintain a Level 1 Fingerprint Clearance Card issued by the Arizona Department of Public Safety (DPS).

7. Documentation, Policies and Records

Providers must maintain comprehensive records that comply with both AHCCCS policies and the federal HCBS Settings Final Rule. This includes detailed service plans, daily visit logs, and documentation of member choices and rights.

Agencies are required to implement electronic visit verification (EVV) for all personal care and attendant care services. Arizona uses a state-mandated EVV system, and providers must ensure all shifts are logged electronically to validate the date, time, location, and type of service provided.

8. Billing, Rates and Claims

Because ALTCS is a managed care program, providers do not typically bill AHCCCS directly via fee-for-service. Instead, claims are submitted to the authorizing MCO or to DES DDD using standard HIPAA-compliant 837P transactions or through the payer's specific provider portal.

Rates for Attendant Care and Personal Care are established by AHCCCS and published in the HCBS Fee Schedule, though MCOs may negotiate specific contracted rates. Providers must ensure that EVV data matches the submitted claims, as discrepancies will result in automatic claim denials.

9. Approval Sequence and Timeline

The approval process begins with obtaining an NPI and registering in APEP. AHCCCS generally processes Provider Enrollment applications within 60 days of submission, provided all documentation and the $750 fee are complete.

After APEP approval, the provider must apply for a DES DDD Qualified Vendor Agreement or solicit contracts from regional MCOs. The QVA process can take 3 to 6 months, while MCO credentialing timelines vary based on network need and the health plan's internal review cycles.

10. Common Denials and Survey Findings

APEP applications are frequently delayed or denied due to missing Electronic Funds Transfer (EFT) forms or failure to respond to AHCCCS requests for additional information within the required timeframe. Incomplete W-9s or mismatched tax IDs are also common administrative hurdles.

During post-enrollment audits by MCOs or DDD, providers often face corrective action plans for failing to maintain current Level 1 Fingerprint Clearance Cards for all staff, or for billing discrepancies where claims do not match the mandated EVV records.

11. Key Contacts and Resources

The AHCCCS Provider Enrollment team and the AHCCCS Solutions Center are the primary contacts for navigating the APEP system and resolving enrollment ticket issues. Providers should utilize the online portals for the fastest response times.

For contracting and waiver-specific questions, providers must engage directly with the DES Division of Developmental Disabilities or the provider relations departments of the regional ALTCS Managed Care Organizations.

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