Arkansas - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-15

Adult Companion Services in Arkansas provide non-medical care, supervision, and socialization to help adults achieve community integration and remain safely at home. Funded primarily through the ARChoices in Home Care 1915(c) waiver, this service is billed in 15-minute increments and is designed to supplement, not replace, state plan personal care.

The single biggest structural barrier to entry for this service is the prerequisite licensure requirement. Arkansas does not issue a standalone "Adult Companion" license; instead, an applicant must already hold a Class A or Class B Home Health Agency license from the Arkansas Department of Health and be actively enrolled as an Arkansas Medicaid Personal Care provider before they can even apply for Adult Companion certification.

1. Service Definition and Scope

In Arkansas, Adult Companion Services are defined as non-medical care, supervision, and socialization provided to assist an adult in achieving community integration goals. These services are authorized under the ARChoices in Home Care Home and Community-Based 2176 Waiver.

The service is strictly non-medical and must be furnished outside the timeframe of other waiver services and state plan personal care. It is designed to ensure the participant's safety and well-being while fostering independence in the community.

• Service Code: S5135 with required modifier U1.
• Unit Measurement: One (1) unit of service equals 15 minutes.
• Annual Limit: Eligible participants may receive up to 1200 hours per State Fiscal Year (SFY) of Adult Companion Services, In-Home Respite, Facility Based Respite Care, or a combination of the three.
• Exclusions: An individual receiving adult companion services cannot receive waiver adult foster care or in-home respite services concurrently.
• Care Plan Requirement: Services must be provided strictly according to the participant’s written ARChoices plan of care.

2. Regulatory and Oversight Agencies

The Arkansas Department of Human Services (DHS) is the umbrella agency that administers the Medicaid program. Within DHS, multiple divisions handle different aspects of provider approval, certification, and enrollment.

Because Adult Companion Services require foundational home health licensure, the Arkansas Department of Health (ADH) also plays a critical role in the initial stages of provider establishment.

• Arkansas Department of Human Services (DHS): The state Medicaid agency responsible for overall waiver administration.
• Division of Medical Services (DMS): Manages the MMIS Provider Portal, sets Medicaid policy, and oversees final provider enrollment and claims.
• Division of Provider Support and Quality Assurance (DPSQA): Conducts environmental regulatory oversight, issues HCBS certifications, and performs compliance site surveys.
• Arkansas Department of Health (ADH): Issues the foundational Class A or Class B Home Health Agency license required to operate.

3. Gatekeeping Prerequisites: Who Can Even Apply

This is the most critical barrier to entry: Arkansas does not allow entities to enroll solely as Adult Companion providers from scratch. There is a strict, multi-tiered prerequisite structure that blocks standalone applications.

Before an application for Adult Companion certification is even accepted by DPSQA, the entity must have already navigated the state's home health licensure process and enrolled in Medicaid for personal care.

• Foundational License Prerequisite: The applicant must hold a current Class A (Skilled) and/or Class B (Non-Skilled) license as a provider of home health services issued by the state.
• Medicaid Enrollment Prerequisite: The applicant must already be fully enrolled as an Arkansas Medicaid Personal Care provider.
• HCBS Settings Rule Assessment: New waiver providers are subject to a mandatory pre-approval assessment of compliance with CMS HCBS Settings requirements by DPSQA before being approved to provide waiver services.
• Certificate of Need (CON): While Arkansas has CON laws for certain facilities, Class B Home Health agencies generally do not require a CON, but the rigorous ADH licensure process serves as the primary structural gate.

4. Licensure and Certification Requirements

Once the prerequisite Home Health license and Personal Care enrollment are secured, the provider must seek specific certification to bill for Adult Companion Services under the ARChoices waiver.

This certification is governed by the ARChoices Provider Manual and requires ongoing compliance with both state licensure rules and federal HCBS waiver regulations.

• Certification Authority: The DPSQA Provider Certification Unit is responsible for certifying providers to deliver care under the waiver once they are enrolled.
• Rule Citation: Governed by Section 213.810 (Adult Companion Services Certification Requirements) of the ARChoices Provider Manual.
• Site Visits: Licensed and certified settings are subject to periodic compliance site-visits by the DPSQA Provider Certification Unit at least once every three years.
• License Maintenance: Per Arkansas Medicaid Provider Manual Section I, license and certification renewals must be forwarded to Medicaid within 30 days of issuance.

5. Medicaid Provider Enrollment

Provider enrollment is conducted electronically through the Arkansas Medicaid Management Information System (MMIS) Provider Portal. Paper applications are generally not accepted for initial enrollment.

The enrollment process is highly sensitive to data discrepancies. The state enforces strict matching rules across all submitted corporate, tax, and licensure documents.

• Enrollment Portal: Applications must be submitted via portal.mmis.arkansas.gov.
• Required Form DMS-675: The Ownership and Conviction Disclosure form is mandatory for every Arkansas Medicaid provider enrollment per 42 CFR §455.104.
• NPI Requirement: An active Type 2 National Provider Identifier (NPI) is required for groups and agencies.
• Tax Documentation: A certified W-9 form with a Tax Identification Number (TIN) that exactly matches IRS records is required.
• Name Matching Rule: The license name, license number, and expiration date on the electronic enrollment application must exactly match Arkansas licensing board records and the W-9.

6. Staffing, Training and Background Checks

Because Adult Companion providers must be licensed Home Health Agencies, their staff must meet the rigorous hiring, background, and training standards dictated by ADH home health regulations.

Additionally, waiver-specific training and technology requirements apply to all direct care workers providing companion services in the home.

• Background Checks: Mandatory state and federal criminal background checks and Arkansas Child and Adult Maltreatment Registry checks are required for all direct care staff.
• EVV Mandate: Companion services require an operational Electronic Visit Verification (EVV) system to electronically check in and out of service appointments.
• HCBS Training: Staff must receive training on the HCBS Settings rule, ensuring services are delivered in a manner that respects participant privacy, dignity, and independence.
• Supervision: Staff must operate under the clinical or administrative supervision structure required by the agency's Class A or Class B Home Health license.

7. Documentation, Policies and Records

Arkansas Medicaid and DPSQA require comprehensive documentation to justify the billing of Adult Companion Services. Audits are frequent, and missing documentation results in immediate recoupment of funds.

Providers must maintain clear boundaries in their documentation between companion services, personal care, and respite care, as these cannot overlap.

• Care Plan Records: Providers must maintain a current copy of the participant’s written ARChoices plan of care that explicitly authorizes Adult Companion Services.
• Service Logs: Must document exact start and stop times (matching EVV data) and detail the specific non-medical socialization or supervision tasks performed.
• Policy Manual: Agencies must maintain written policies on participant rights, incident reporting, universal precautions, and HCBS settings compliance.
• Record Retention: All Medicaid billing and service records must be retained for a minimum of five years from the date of service or until all audit questions are resolved.

8. Billing, Rates and Claims

Billing for Adult Companion Services is processed through the MMIS portal. Providers must establish electronic payment routing before they can receive funds.

Failure to properly configure Electronic Fund Transfer (EFT) and Electronic Remittance Advice (ERA) setups is a leading cause of payment delays for newly approved providers.

• Billing Codes: Claims must be submitted using procedure code S5135 with the required modifier U1.
• EFT Authorization: Must be submitted via the MMIS Portal with a voided check or bank verification letter (deposit slips are not accepted).
• ERA Setup: 835 Electronic Remittance Advice files must be configured through the provider's clearinghouse or billing system for payment reconciliation.
• Concurrent Billing Prohibition: Providers cannot bill for Adult Companion Services during the same timeframe as state plan personal care or waiver in-home respite.

9. Approval Sequence and Timeline

Becoming an Adult Companion provider in Arkansas is a lengthy, multi-step process due to the prerequisite licensure requirements. Prospective providers should plan for a timeline of 6 to 12 months.

Steps must be completed in a specific order, as the MMIS portal will reject applications that lack the foundational license or prerequisite personal care enrollment.

• Step 1: Apply for and obtain a Class A or Class B Home Health Agency license from the Arkansas Department of Health.
• Step 2: Enroll as an Arkansas Medicaid Personal Care provider via the MMIS Provider Portal.
• Step 3: Request Adult Companion certification from the DPSQA Provider Certification Unit.
• Step 4: Undergo and pass the initial HCBS Settings compliance site visit by DPSQA.
• Step 5: Submit the supplementary Adult Companion enrollment application via the MMIS Provider Portal.

10. Common Denials and Survey Findings

The Arkansas DHS Provider Enrollment unit frequently denies applications for administrative errors, while DPSQA issues survey citations for operational non-compliance.

Understanding these common pitfalls can save providers months of delays and prevent costly audit recoupments.

• Name Mismatches: The single most common cause of Arkansas Medicaid application denials; the name on the W-9, application, and licenses must match exactly.
• Missing Attachments: Applications are frequently rejected for failing to upload the required DMS-675 form or a valid EFT authorization.
• EVV Non-Compliance: Surveyors frequently cite providers for failing to accurately capture electronic check-ins and check-outs for companion services.
• Overlapping Services: Audit findings commonly occur when providers mistakenly bill Adult Companion services at the same time as state plan personal care.

11. Key Contacts and Resources

Navigating the Arkansas Medicaid system requires interaction with multiple state portals and divisions. Providers should bookmark the primary regulatory manuals and enrollment sites.

The AFMC MMIS Outreach team is a valuable resource for new providers struggling with portal navigation or billing rules.

• MMIS Provider Portal: portal.mmis.arkansas.gov (used for electronic enrollment applications and claims submission).
• DHS Provider Enrollment: Accessed via the DHS Medical Services division for policy updates and the ARChoices Provider Manual.
• DPSQA Licensure and Certification: The division responsible for HCBS site visits and waiver certifications.
• AFMC MMIS Outreach: Specialists available to help providers with questions about Arkansas Medicaid policy, billing requirements, and claim-processing.

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