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

Last reviewed: 2026-09-09

The Arkansas Department of Human Services (DHS) Division of Medical Services (DMS) and Division of Developmental Disabilities Services (DDS) authorize Respite Care Services under the Community and Employment Supports (CES) Waiver and ARChoices in Homecare programs.

Approval requires applicants to first hold a Class A or Class B Home Health license or be an enrolled Medicaid personal care provider before billing for in-home respite. Providers must also implement an Electronic Visit Verification (EVV) system and obtain a Medicaid Practitioner Identification Number (PIN) for every rendering caregiver.

1. Service Definition and Scope

In Arkansas, Respite Care Services provide temporary, short-term relief to unpaid primary caregivers. The service ensures the Medicaid beneficiary continues to receive necessary supervision, support, and assistance with activities of daily living during the caregiver's absence.

Services can be delivered in the individual's home, a facility-based environment, or a community setting, depending on the specific waiver authorization and the provider's licensure type.

• Service Scope: Temporary supervision and assistance with daily living activities during planned or emergency caregiver absences.
• Delivery Settings: In-home care, facility-based environments, and approved community settings.
• Waiver Authorities: Community and Employment Supports (CES) Waiver and ARChoices in Homecare.
• Duration Limits: Authorized in short-term increments, often capped at a specific number of hours per year based on the individual's plan of care.
• Excluded Activities: Cannot be billed simultaneously with personal care or homemaker services for the same exact time period.
• Target Populations: Individuals with developmental disabilities, aging needs, or complex medical conditions requiring continuous support.

2. Regulatory and Oversight Agencies

Multiple divisions within the Arkansas Department of Human Services (DHS) oversee respite care. The Division of Medical Services (DMS) handles Medicaid enrollment and billing, while the Division of Developmental Disabilities Services (DDS) approves waiver providers.

The Division of Provider Services and Quality Assurance (DPSQA) oversees facility licensure and manages the Arkansas Lifespan Respite registry.

• Arkansas Department of Human Services (DHS): The umbrella agency managing Medicaid and HCBS programs (https://humanservices.arkansas.gov).
• Division of Medical Services (DMS): Administers Medicaid funding, provider enrollment, and the MMIS portal (https://humanservices.arkansas.gov/divisions-shared-services/medical-services).
• Division of Developmental Disabilities Services (DDS): Approves and monitors CES waiver service providers (https://humanservices.arkansas.gov/divisions-shared-services/developmental-disabilities-services).
• Division of Provider Services and Quality Assurance (DPSQA): Licenses home health agencies and manages the Lifespan Respite registry (https://humanservices.arkansas.gov/divisions-shared-services/provider-services-quality-assurance).
• Arkansas Medicaid Health Care Provider Portal: The official MMIS system for enrollment and claims (https://portal.mmis.arkansas.gov).
• Centers for Medicare & Medicaid Services (CMS): Provides federal oversight for Arkansas HCBS waivers (https://www.cms.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

Arkansas does not issue a standalone 'Respite Care License' for all settings. To provide in-home respite services under Medicaid, an applicant must already hold a specific foundational license or enrollment status. There are no Certificate of Need (CON) requirements specifically for respite, but CON applies if the provider is establishing a new Home Health Agency to meet the prerequisite.

Applicants must be fully established business entities registered with the Arkansas Secretary of State and possess an active National Provider Identifier (NPI) before initiating the Medicaid enrollment process.

• Foundational Licensure: Providers must hold a current Class A and/or Class B Home Health license issued by DPSQA, or be an enrolled Medicaid personal care provider.
• Business Registration: Must be registered and in good standing with the Arkansas Secretary of State.
• Federal Identifiers: Must possess an IRS Employer Identification Number (EIN) and a Type 2 Organizational NPI.
• EVV Vendor Selection: Must select an EVV vendor and submit the EVV Declaration Form (DMS-9654) prior to providing in-home services.
• Waiver Certification: Must complete the DDS HCBS Waiver Provider Packet and pass a readiness review for CES waiver participation.
• No Moratoria: There are currently no statewide moratoria or closed networks blocking new respite provider applications.

4. Licensure and Certification Requirements

Because respite is often an add-on service for existing agencies, the licensure requirements mirror those of the underlying agency type. Home Health Agencies providing respite must comply with DPSQA Class A or Class B regulations.

Providers may also complete the free Respite Care Certification Program or the UAMS-Schmieding Caregiver's REST Training Program to be listed on the Arkansas Lifespan Respite Search Locator.

• Class A/B License: Required for agencies providing skilled or comprehensive home health services that include respite.
• DDS Certification: Required for agencies serving the developmentally disabled population under the CES waiver.
• Registry Certification: Optional but recommended completion of the UAMS-Schmieding Caregiver's REST Training Program for registry inclusion.
• Liability Insurance: Must maintain active general and professional liability insurance policies.
• Policy Manual: Must develop a comprehensive policy manual covering intake, client rights, and emergency procedures.
• Physical Plant Standards: Facility-based respite providers must pass DPSQA physical plant and fire safety inspections.

5. Medicaid Provider Enrollment

All respite providers must enroll through the Arkansas Medicaid Health Care Provider Portal. The state mandates that applications, revalidations, and Practitioner Identification Number (PIN) requests be submitted electronically.

Providers must submit specific forms, including the Provider Application (DMS-652) and the Medicaid Contract (DMS-653), along with ownership disclosures and electronic funds transfer details.

• Application Portal: Must apply online via the Arkansas Medicaid Health Care Provider Portal (https://portal.mmis.arkansas.gov).
• Form DMS-652: The official Arkansas Medicaid Provider Application form.
• Form DMS-653: The official Arkansas Medicaid Provider Contract.
• Form W-9: Must be submitted with the exact matching legal name and Tax ID (FEIN).
• EFT Authorization: Requires a voided check or signed bank letter to establish Electronic Funds Transfer for claims payment.
• Application Fee: Subject to the CMS-mandated institutional provider application fee unless enrolled in Medicare or another state's Medicaid program.

6. Staffing, Training and Background Checks

Arkansas requires rigorous screening and tracking of all rendering respite staff. Every caregiver must be assigned a unique Medicaid Practitioner Identification Number (PIN) linked to the agency.

Agencies must ensure no staff member is excluded from federal health programs and must conduct fingerprint-based criminal background checks through the Arkansas State Police.

• Medicaid PIN: Agencies must obtain a unique PIN from DHS for every rendering caregiver before claims can be submitted.
• Background Checks: Mandatory fingerprint-based state and national criminal history checks for all patient-facing staff.
• Exclusion Screening: Must verify staff are not on the OIG LEIE or state debarment lists prior to hire and monthly thereafter.
• Basic Training: Staff must be trained in CPR, first aid, and the specific needs outlined in the participant's plan of care.
• EVV Compliance: Staff must be trained on the agency's Electronic Visit Verification system to log start and end times.
• Supervision: Agencies must maintain supervision logs documenting oversight of rendering respite workers.

7. Documentation, Policies and Records

Arkansas Medicaid requires strict documentation to substantiate every respite claim. If multiple services (like homemaker and respite) are provided on the same day, the documentation must clearly delineate the exact times for each.

Agencies must maintain a copy of the participant's plan of care and ensure all service logs include the signature and title of the rendering staff member.

• Plan of Care: A current, approved copy of the participant's plan of care must be maintained in the client file.
• Service Logs: Must include a brief description of services, date, actual start/stop times, and the rendering staff's signature.
• EVV Records: In-home respite requires electronic verification of the visit location, date, and time via the EVV system.
• Incident Reporting: Must maintain a documented system for reporting and tracking critical incidents and grievances.
• Record Retention: All clinical and billing records must be retained for a minimum of five years from the date of service.
• Delineation of Services: Time logs must explicitly separate respite hours from personal care or attendant care hours.

8. Billing, Rates and Claims

Respite services are billed to Arkansas Medicaid using specific HCPCS procedure codes authorized in the participant's plan of care. Claims for in-home respite must include the rendering provider's PIN and be supported by EVV data.

Rates are established by the Division of Medical Services and published in the official Medicaid fee schedules. Providers must bill electronically through the MMIS portal.

• Billing System: Claims are submitted electronically via the Arkansas Medicaid Health Care Provider Portal.
• Rendering Provider ID: The caregiver's unique PIN must be listed in the Rendering Provider ID field on every claim.
• EVV Mandate: Claims for in-home respite will deny if not matched with corresponding EVV visit data.
• Procedure Codes: Billed using standard HCBS HCPCS codes (e.g., S5150 or S5151) as specified in the waiver manual.
• Rate Publication: Current reimbursement rates are published on the DMS fee schedule webpage.
• Third-Party Liability: Medicaid is the payer of last resort; providers must exhaust other applicable coverage first.

9. Approval Sequence and Timeline

The process to become a fully billing respite provider in Arkansas involves multiple sequential phases, starting with business formation and foundational licensure.

Medicaid enrollment typically takes 45 to 90 days, provided the application is complete and submitted electronically. Waiver-specific approvals from DDS add an additional 30 to 60 days to the timeline.

• Phase 1: Business formation, obtaining EIN, NPI, and foundational Home Health license or Personal Care enrollment (Timeline varies).
• Phase 2: Submission of the Medicaid Provider Enrollment application via the portal (45-90 days).
• Phase 3: Submission of the DDS HCBS Waiver Provider Packet and readiness review (30-60 days).
• Phase 4: EVV system setup, vendor declaration (DMS-9654), and staff PIN requests (15-30 days).
• Phase 5: Final approval, receipt of Medicaid provider number, and commencement of billing.
• Revalidation: Providers must revalidate their Medicaid enrollment every five years or upon request by DMS.

10. Common Denials and Survey Findings

The Arkansas Medicaid Provider Enrollment Unit frequently returns or denies applications due to clerical errors. The most common issue is a name mismatch across submitted documents.

During audits, DPSQA and DMS frequently cite providers for failing to properly delineate overlapping service times or failing to maintain compliant EVV records.

• Name Mismatch: Application denied if the legal name on the W-9, license, and application do not match exactly.
• Incorrect W-9: Denials occur if a group practice submits a W-9 with an individual's SSN instead of the group's Tax ID.
• Missing Attachments: Failure to upload required licenses, voided checks for EFT, or ownership disclosures in the portal.
• EVV Non-Compliance: Recoupment of funds during audits if billed claims lack corresponding electronic visit data.
• Expired Credentials: Termination of Medicaid enrollment if foundational licenses or certifications expire for 6 months or longer.
• Documentation Overlap: Audit findings for billing respite and personal care simultaneously without clear time delineation.

11. Key Contacts and Resources

Prospective providers should utilize the official Arkansas DHS portals and division websites for the most current manuals, forms, and fee schedules.

The Medicaid Provider Enrollment Unit and the Division of Developmental Disabilities Services are the primary contacts for application status and waiver program questions.

• Arkansas Medicaid Provider Portal: https://portal.mmis.arkansas.gov
• DHS Provider Enrollment Webpage: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/provider-enrollment
• Division of Developmental Disabilities Services (DDS): https://humanservices.arkansas.gov/divisions-shared-services/developmental-disabilities-services
• DDS Provider Info Email: [email protected]
• Arkansas Lifespan Respite Registry: https://humanservices.arkansas.gov/divisions-shared-services/provider-services-quality-assurance/arkansas-lifespan-respite/respite-worker-registry/
• Division of Provider Services and Quality Assurance (DPSQA): https://humanservices.arkansas.gov/divisions-shared-services/provider-services-quality-assurance

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