Arizona - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Arizona Department of Economic Security (DES) Division of Developmental Disabilities (DDD) administers Respite Care Services under the Arizona Long Term Care System (ALTCS) waiver. Providers must secure a Qualified Vendor Agreement (QVA) through the active RFQVA DDD-2024 procurement before they can bill for short-term relief care provided to unpaid primary caregivers.

Approval requires navigating a dual-track system where agencies first submit their application to the DDD Contracts Unit, followed by a mandatory credentialing phase through the DDD Credentialing Unit. In-home respite does not require a separate facility license from the Arizona Department of Health Services (ADHS), but providers offering facility-based group respite must obtain an Adult Day Health Care license prior to enrollment.

1. Service Definition and Scope

Respite Care Services in Arizona provide short-term, temporary care to individuals enrolled in the ALTCS DDD waiver, allowing their unpaid primary caregivers to step away. The service ensures the member's health, safety, and supervision needs are met during the caregiver's absence.

This service can be delivered in the member's home, the provider's home, or a licensed community setting. It includes assistance with activities of daily living, supervision, and engaging the member in routine activities.

• Service Code: RSP (Respite).
• Delivery Settings: Member's home, provider's home, or an ADHS-licensed facility.
• Annual Limits: Typically capped at 600 hours per member per benefit year, spanning October 1 through September 30.
• EVV Mandate: In-home respite is subject to Electronic Visit Verification (EVV) under the 21st Century Cures Act.

2. Regulatory and Oversight Agencies

The Arizona Health Care Cost Containment System (AHCCCS) serves as the single state Medicaid agency, overseeing all waiver funding and provider enrollment. The DES Division of Developmental Disabilities (DDD) acts as the operating agency for the IDD waiver, managing vendor contracts, credentialing, and daily oversight.

For providers offering facility-based respite, the Arizona Department of Health Services (ADHS) Bureau of Medical Facilities Licensing regulates and inspects the physical locations.

• Medicaid Agency: Arizona Health Care Cost Containment System (AHCCCS) (https://www.azahcccs.gov/).
• Operating Agency: DES Division of Developmental Disabilities (DDD) (https://des.az.gov/services/disabilities/developmental-disabilities).
• Licensing Authority: Arizona Department of Health Services (ADHS) (https://www.azdhs.gov/).
• Enrollment Portal: AHCCCS Provider Enrollment Portal (APEP) (https://www.azahcccs.gov/PlansProviders/APEP/).

3. Gatekeeping Prerequisites: Who Can Even Apply

To provide Respite Care Services to DDD members, an agency must first apply for and be awarded a Qualified Vendor Agreement (QVA) under the current Request for Qualified Vendor Agreement (RFQVA DDD-2024). This is a continuous open procurement, but applications are only accepted through the state's designated vendor portal.

Applicants cannot enroll directly with AHCCCS for this service without first securing the DDD contract and passing the DDD Credentialing Unit's initial review.

• Procurement Vehicle: RFQVA DDD-2024, the mandatory contracting mechanism for all DDD HCBS providers.
• System Access: Applications must be submitted through the Qualified Vendor Application and Directory System (QVADS) or its current DES equivalent.
• NPI Requirement: Agencies must obtain a National Provider Identifier (NPI) before initiating the RFQVA process.
• Facility Prerequisite: If providing out-of-home group respite, the ADHS facility license must be active before the RFQVA is approved.

4. Licensure and Certification Requirements

Arizona does not issue a specific "Respite Agency" license for in-home care. Instead, agencies are certified through the DDD Qualified Vendor credentialing process, which verifies compliance with Division Medical Policy Manual Chapter 950 and Provider Manual Chapter 48.

If a provider intends to offer group respite outside the home, they must obtain an Adult Day Health Care License or a similar facility license from ADHS under Arizona Administrative Code Title 9.

• In-Home Exemption: No ADHS facility license is required for services delivered in the member's own home.
• Facility License: Adult Day Health Care license required for facility-based group respite.
• DDD Credentialing: Mandatory Initial Credentialing Checklist submission to the DDD Credentialing Unit.
• Recredentialing: Required every three years to maintain the Qualified Vendor Agreement.

5. Medicaid Provider Enrollment

Once the DDD Contracts Unit approves the RFQVA and the Credentialing Unit clears the agency, the provider must enroll in the AHCCCS Provider Enrollment Portal (APEP). The agency enrolls as a Facility/Agency/Organization (FAO) or Atypical Agency depending on their exact service mix.

Providers must use the Provider Enrollment Screening Glossary (PEP-903) to determine their exact enrollment type and risk category, which dictates application fees and site visit requirements.

• Enrollment System: AHCCCS Provider Enrollment Portal (APEP).
• Provider Type: Typically enrolled under Provider Type 39 (Habilitation Provider) or an Atypical Agency designation.
• Application Fee: Required for institutional providers unless enrolled as an Atypical (non-medical) provider without an NPI.
• Background Screening: Subject to high-risk screening protocols including fingerprint-based criminal background checks for owners with 5% or more interest.

6. Staffing, Training and Background Checks

Direct Support Professionals (DSPs) providing respite must meet strict state-mandated training and background requirements before working with members. Arizona places a heavy emphasis on abuse prevention and member rights through its proprietary Article 9 training.

All staff must maintain an active Level 1 Fingerprint Clearance Card issued by the Arizona Department of Public Safety.

• Minimum Qualifications: Must be at least 18 years old with a high school diploma or GED.
• Background Check: Active Level 1 Fingerprint Clearance Card required prior to hire.
• State Training: Mandatory completion of Arizona Administrative Code Article 9 training (Managing Inappropriate Behaviors).
• Safety Certifications: Current CPR and First Aid certification required.

7. Documentation, Policies and Records

Qualified Vendors must maintain comprehensive administrative and member records in accordance with their DDD contract. Because in-home respite is subject to the 21st Century Cures Act, strict adherence to Electronic Visit Verification (EVV) data collection is mandatory.

Agencies must also maintain detailed incident reporting policies, submitting critical incidents to the DDD Quality Assurance unit within 24 hours.

• EVV Compliance: Must capture six data points (member, caregiver, service, date, location, start/end times) for every in-home shift.
• Member Records: Must retain service plans, daily progress notes, and timesheets for at least five years.
• Incident Reporting: Immediate reporting of abuse, neglect, or exploitation to DDD and Adult/Child Protective Services.
• Credential Tracking: Agencies must maintain a tracking system for staff CPR, Article 9, and Fingerprint Clearance Card expirations.

8. Billing, Rates and Claims

Respite services are reimbursed according to the DDD published rate schedule, which is updated annually. Claims for in-home respite must be supported by validated EVV data; claims lacking matching EVV records will be denied by the AHCCCS MMIS.

Providers bill using standard HCPCS codes, with modifiers applied to differentiate between in-home, out-of-home, and continuous care.

• HCPCS Codes: Typically billed using S5150 (15-minute increments) or S5151 (per diem).
• Rate Schedule: Published on the DES DDD website under Qualified Vendor Rates.
• EVV System: Sandata is the state-sponsored EVV vendor, though alternate approved systems may be used.
• Claim Submission: Claims are submitted directly to DDD or the member's managed care health plan depending on enrollment.

9. Approval Sequence and Timeline

The path to becoming a billing provider is sequential and cannot be expedited. Agencies must first prepare their business infrastructure, then apply for the DDD contract, pass credentialing, and finally enroll with AHCCCS.

The entire process from RFQVA submission to active APEP enrollment typically takes 4 to 6 months, depending on application accuracy and state volume.

• Step 1: Submit RFQVA DDD-2024 application to the DDD Contracts Unit.
• Step 2: Submit Initial Credentialing Checklist to the DDD Credentialing Unit (up to 60 days for review).
• Step 3: Receive Qualified Vendor Agreement award.
• Step 4: Complete AHCCCS APEP enrollment (30-60 days).

10. Common Denials and Survey Findings

Applications are frequently delayed or denied during the DDD Credentialing phase due to incomplete documentation or failure to meet the strict policy manual standards. New applicants often underestimate the detail required in their agency policies.

During post-enrollment audits, the most common citations involve lapsed staff credentials and EVV non-compliance.

• RFQVA Rejection: Missing required policy attachments or incomplete business plans.
• Credentialing Delays: Failure to submit the Initial Credentialing Checklist directly to the Credentialing Unit (sending it to Contracts instead).
• Audit Findings: Staff providing services with expired Level 1 Fingerprint Clearance Cards.
• Billing Denials: EVV exceptions not cleared, resulting in unmatched claims.

11. Key Contacts and Resources

Providers should rely on the official DES and AHCCCS portals for the most current manuals, rate sheets, and application checklists. The DDD Credentialing Unit and AHCCCS Provider Enrollment team offer dedicated help desks for applicants.

Regularly reviewing the AHCCCS Provider Enrollment Policy Manual (PEPM) is essential for maintaining compliance.

• DDD Qualified Vendor Page: https://des.az.gov/services/disabilities/developmental-disabilities/vendors-providers/current
• DDD Credentialing Unit: https://des.az.gov/services/disabilities/developmental-disabilities/vendors-providers/credentialing
• AHCCCS Provider Enrollment: https://www.azahcccs.gov/PlansProviders/APEP/
• AHCCCS Solutions Center: https://servicenow.azahcccs.gov/gsp

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