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Arkansas - Skilled Respite Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

In Arkansas, Skilled Respite Service is funded primarily through the Community and Employment Supports (CES) Waiver and the ARChoices in Homecare Waiver, and is overseen by the Department of Human Services (DHS). The service provides temporary relief to primary caregivers by utilizing licensed nursing staff (LPNs or RNs) for individuals whose medical needs exceed the capabilities of unlicensed caregivers.

To become an approved provider, agencies must first navigate the state's managed care system, known as the Provider-Led Arkansas Shared Savings Entity (PASSE) model. Providers cannot simply enroll in Medicaid and begin billing; they must successfully contract and credential with one or more of the designated PASSE organizations that manage the waiver populations.

1. Service Definition and Scope

Skilled Respite Service in Arkansas is defined as short-term, temporary relief provided to the primary caregiver of an individual with significant medical or developmental needs. It is specifically delivered by licensed nursing personnel (Registered Nurses or Licensed Practical Nurses) when the individual's care requirements are too complex for an unlicensed personal care aide or standard respite worker.

The service can be provided in the individual's home or in an approved facility setting. It is designed to prevent institutionalization by supporting the family unit, but it cannot be used for routine childcare or while the primary caregiver is at work.

2. Regulatory and Oversight Agencies

The Arkansas Department of Human Services (DHS) is the umbrella agency responsible for Medicaid and waiver services. Within DHS, the Division of Provider Services and Quality Assurance (DPSQA) handles provider certification and licensure, while the Division of Developmental Disabilities Services (DDS) and the Division of Aging, Adult, and Behavioral Health Services (DAABHS) manage the specific waiver populations.

Additionally, the PASSE organizations act as the managed care entities responsible for network adequacy, credentialing, and claims payment for the CES Waiver and other high-need populations.

3. Gatekeeping Prerequisites: Who Can Even Apply

The most significant structural prerequisite for providing Skilled Respite under the CES Waiver in Arkansas is the requirement to contract with a Provider-Led Arkansas Shared Savings Entity (PASSE). Arkansas utilizes this managed care model for its high-need behavioral health and developmental disability populations. A provider cannot simply enroll in fee-for-service Medicaid and bill for these waiver services; they must be accepted into a PASSE network.

Furthermore, to provide skilled nursing services, the agency must hold an appropriate license, typically a Home Health Agency license or a Private Duty Nursing license issued by the Arkansas Department of Health, before applying for Medicaid enrollment or PASSE credentialing.

4. Licensure and Certification Requirements

Because Skilled Respite requires the use of licensed nurses, the provider agency must be licensed by the Arkansas Department of Health (ADH) to deliver nursing services in the home. This typically requires a Class A Home Health Agency license or a Private Duty Nursing agency license.

In addition to ADH licensure, providers must obtain certification from the relevant DHS division (DDS for the CES Waiver or DAABHS for ARChoices) to provide waiver-specific services. This certification process verifies that the agency understands and complies with waiver rules, incident reporting, and person-centered planning requirements.

5. Medicaid Provider Enrollment

After obtaining the necessary licensure and waiver certification, providers must enroll in Arkansas Medicaid through the DHS Health Care Provider Portal. Arkansas requires the use of the current enrollment forms and mandates electronic submission through the portal for most provider types to reduce errors and processing times.

Providers must pay the federally mandated ACA application fee unless they have already paid it to Medicare or another state's Medicaid program. The enrollment process includes submitting the W-9, licensure documents, and ownership disclosures. The name on all submitted documents must match exactly to avoid denial.

6. Staffing, Training and Background Checks

Staff delivering Skilled Respite must be licensed as either a Registered Nurse (RN) or a Licensed Practical Nurse (LPN) in Arkansas. LPNs must practice under the supervision of an RN as dictated by the Arkansas Nurse Practice Act.

Arkansas mandates federal fingerprint-based background checks for all high-risk providers and their owners with a 5% or greater interest. Additionally, all direct care staff must clear the Arkansas Child Maltreatment Central Registry, the Adult Abuse Central Registry, and state criminal background checks.

7. Documentation, Policies and Records

Providers must maintain comprehensive records that comply with both ADH nursing regulations and DHS waiver requirements. This includes a detailed plan of care signed by a physician, nursing notes for each shift, and documentation of the specific skilled tasks performed during the respite period.

Agencies must have written policies covering emergency procedures, infection control, grievance processes, and incident reporting. Records must be retained for a minimum of five years from the date of service or until all audits are resolved.

8. Billing, Rates and Claims

For waiver populations managed by a PASSE, claims for Skilled Respite are submitted directly to the individual's PASSE, not to the state MMIS. The PASSE establishes the specific billing procedures, claim formats, and prior authorization requirements.

Rates for Skilled Respite are typically negotiated with the PASSE, though they are informed by the state's fee schedule. Providers must ensure that the service is included in the member's Person-Centered Service Plan (PCSP) and authorized by the PASSE before delivering care.

9. Approval Sequence and Timeline

The approval process is sequential and cannot be expedited by submitting applications concurrently. An agency must first obtain its Home Health or Private Duty Nursing license from the Arkansas Department of Health, which involves a structural review and initial survey.

Once licensed, the provider applies for waiver certification from DDS or DAABHS. Following certification, the provider enrolls in Arkansas Medicaid via the Provider Portal. Finally, the enrolled provider must complete credentialing and contracting with the PASSE organizations, which can take an additional 90-120 days.

10. Common Denials and Survey Findings

Medicaid enrollment applications are frequently denied or returned due to simple administrative errors. The Arkansas DHS Provider Enrollment unit cites name mismatches (where the name on the W-9, license, and application do not match exactly) and incorrect W-9 completion as top reasons for denial.

During ADH or DHS surveys, common citations include failure to maintain current RN/LPN license verifications in personnel files, inadequate documentation of the skilled need during the respite shift, and failure to report incidents within the mandated timeframes.

11. Key Contacts and Resources

Providers should utilize the DHS Health Care Provider Portal for enrollment and updates. The DHS Provider Enrollment webpage offers the Required Document Finder and current forms.

For licensure questions, contact the Arkansas Department of Health. For waiver-specific inquiries, contact DDS or DAABHS. Providers must also engage directly with the PASSE organizations for contracting.

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