Louisiana - Assisted Living Facility — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Louisiana Department of Health (LDH) Health Standards Section licenses assisted living under the consolidated category of Adult Residential Care Providers (ARCP), governed by Louisiana Administrative Code Title 48, Part I, Chapter 68. Facilities are licensed across four modules, ranging from Level 1 Personal Care Homes to Level 4 Adult Residential Care, which permits limited nursing services and medication administration by licensed staff. Prospective providers of Level 4 facilities must secure approval through the state's Facility Need Review (FNR) process before an application for licensure will be accepted.

Louisiana does not currently cover ARCP services under its Medicaid State Plan or 1915(c) Home and Community-Based Services (HCBS) waivers. Consequently, while providers must complete the rigorous state licensure process to operate legally, they function entirely on a private-pay or long-term care insurance basis rather than enrolling as Medicaid HCBS waiver providers through the state's fiscal agent.

1. Service Definition and Scope

Adult Residential Care Providers (ARCPs) offer lodging, meals, medication administration, intermittent nursing services, and assistance with activities of daily living to two or more unrelated adults. The state divides ARCPs into four distinct modules based on facility capacity and the acuity of care provided.

While lower levels focus on basic personal care and shelter, the Level 4 module operates as a medical model, allowing for more advanced interventions by licensed nursing personnel. Facilities may also operate specialized Alzheimer's units if they meet additional structural and training mandates.

• Level 1: Personal Care Homes serving 2 to 8 residents in a setting designed similarly to a single-family dwelling.
• Level 2: Shelter Care Homes serving 9 or more residents.
• Level 3: Assisted Living Facilities, which require independent apartments or units for residents.
• Level 4: Adult Residential Care, a medical model allowing intravenous therapy on a time-limited basis by licensed nursing staff.
• Dementia Care Units: Facilities operating Alzheimer's units must provide enclosed adjacent outdoor areas and specialized locking arrangements approved by the state.

2. Regulatory and Oversight Agencies

The primary regulatory body for ARCPs is the LDH Health Standards Section (HSS), which handles licensing, surveys, and complaint investigations. HSS enforces compliance with the Louisiana Administrative Code and state statutes.

Because Medicaid does not fund this service, the Medicaid program offices and managed care organizations do not have direct oversight of ARCP operations or network adequacy.

• Licensing Agency: [LDH Health Standards Section](https://ldh.la.gov/health-standards-section) processes initial and renewal ARCP applications.
• Survey Agency: LDH HSS conducts initial, annual, and complaint-driven inspections of all licensed ARCPs.
• Medicaid Fiscal Agent: [Gainwell Technologies](https://www.lamedicaid.com) manages the MMIS, though ARCPs do not enroll here.
• Statutory Authority: The Louisiana Legislature establishes ARCP mandates under [RS 40:2166.3](https://www.legis.la.gov/legis/Law.aspx?d=409893).

3. Gatekeeping Prerequisites: Who Can Even Apply

Before submitting an ARCP licensure application, prospective providers of Level 4 facilities must secure approval through the state's Facility Need Review (FNR) process. This is a strict structural precondition; LDH will not process a Level 4 application without prior FNR approval.

Because Louisiana does not utilize Medicaid waiver enrollment for this service, waiver-specific network closures, managed care contracting prerequisites, or Medicaid moratoria do not apply to ARCPs.

• Facility Need Review (FNR): Required prior to licensure application for any Level 4 Module ARCP.
• Medicaid Moratoria: Not applicable, as the service is not Medicaid-funded.
• Geographic Restriction: Licenses are valid only for one specific geographic location and the named applicant.
• Zoning and Fire Marshal: Local zoning approval and Office of State Fire Marshal clearance must precede the HSS application.

4. Licensure and Certification Requirements

ARCP licensure is governed by LAC 48:I.Chapter 68. Applicants must submit a complete packet to LDH HSS, and the state enforces strict deadlines for responsiveness during the review phase.

Failure to provide missing information within 90 days of a request results in the immediate termination of the application process, requiring the provider to start over with new fees.

• Application Form: HSS-AC-1 License Application.
• Base Fee: $600 non-refundable initial application fee.
• Per-Unit Fee: $5 per unit added to the base fee.
• Submission Method: Express mail must use USPS Priority Mail or Priority Mail Express (FedEx and UPS are explicitly prohibited).
• Survey Readiness: Applicant must notify LDH of readiness for an initial survey within 90 days of packet approval.

5. Medicaid Provider Enrollment

Louisiana Medicaid does not cover home and community-based services in adult residential care facilities. Therefore, there is no Medicaid provider enrollment process, MMIS registration, or waiver certification required or available for ARCPs.

Facilities operate strictly on private pay, VA benefits, or private long-term care insurance. Providers do not interact with Gainwell Technologies for ARCP services.

• Medicaid State Plan: Does not include ARCP or assisted living services.
• 1915(c) Waivers: No Louisiana HCBS waivers currently fund ARCP services.
• Enrollment Portal: The [Louisiana Medicaid Provider Portal](https://www.lamedicaid.com) is not used by ARCPs.
• Reimbursement: Facilities rely entirely on private funding sources.

6. Staffing, Training and Background Checks

ARCP staff must meet specific training requirements, particularly regarding medication administration and dementia care. Facilities must ensure staff are trained prior to providing direct care.

The state distinguishes clearly between medication assistance, which unlicensed staff may perform, and medication administration, which requires a nursing license.

• Medication Assistance: Unlicensed staff may assist with self-administration only after documented, annual training on policies and limitations.
• Medication Administration: Must be performed by an RN, LPN, or licensed physician (Level 4 allows limited IV therapy by RNs/physicians).
• Dementia Training (Initial): Direct care staff in Alzheimer's units must complete 8 hours of dementia-specific training within 90 days of hire.
• Dementia Training (Annual): 8 hours of ongoing dementia-specific training required annually for direct care staff.

7. Documentation, Policies and Records

Licensed ARCPs must maintain comprehensive operational policies, resident records, and infection control protocols. Menus and dietary plans also require professional oversight and documentation.

State surveyors review these records during annual and complaint inspections to ensure compliance with LAC 48:I.Chapter 68.

• Infection Control: Written policies approved by the governing body addressing PPE and CDC/OSHA standards.
• Dietary Records: Menus must be reviewed and approved by a nutritionist or registered licensed dietician.
• Service Plans: Facilities must maintain individualized resident contracts or service plans detailing care and special diets.
• Emergency Preparedness: Documented EP plans required as part of the core licensing standards.

8. Billing, Rates and Claims

Because ARCPs are not Medicaid providers in Louisiana, they do not submit claims through Gainwell Technologies or utilize Medicaid procedure codes. Facilities set their own private-pay rates based on the module level and resident service plans.

All financial agreements must be clearly documented in the resident contract prior to admission.

• Medicaid Rates: None established; service is not covered.
• Procedure Codes: Not applicable for room, board, or personal care in an ARCP.
• Billing System: Facilities use proprietary private billing systems.
• Resident Contracts: Rates, fees, and payment terms must be clearly delineated in the resident admission agreement.

9. Approval Sequence and Timeline

The path to opening an ARCP involves securing prerequisite approvals, submitting the HSS application, and passing the initial survey. The state enforces strict deadlines for applicant responsiveness.

Missing any of the 90-day windows for documentation or survey readiness results in the forfeiture of the application and fees.

• Step 1: Obtain Facility Need Review approval (if applying for a Level 4 module).
• Step 2: Submit HSS-AC-1 application and fees via USPS Priority Mail.
• Step 3: Resolve any missing information requests from LDH within 90 days.
• Step 4: Notify LDH of readiness for the initial licensing survey within 90 days of packet approval.
• Step 5: Pass the HSS initial survey to receive the 1-year license.

10. Common Denials and Survey Findings

Applications are frequently closed due to missed deadlines or incorrect submission methods. LDH HSS strictly enforces the 90-day response windows.

During surveys, HSS inspectors focus heavily on medication management, life safety compliance, and proper documentation of staff training.

• Application Closure: Terminated if missing information is not submitted within 90 days.
• Survey Readiness Failure: Application closed if the facility fails to notify LDH of survey readiness within 90 days of packet approval.
• Mailing Errors: Packets rejected if sent via FedEx or UPS instead of the mandated USPS Priority Mail.
• Medication Errors: Citations for unlicensed staff administering medications outside of permitted self-administration assistance parameters.

11. Key Contacts and Resources

Prospective ARCP operators must coordinate primarily with the LDH Health Standards Section for all licensing matters.

Providers should regularly check the HSS website for updates to the Louisiana Administrative Code and licensing forms.

• Licensing Agency: [LDH Health Standards Section (HSS)](https://ldh.la.gov/health-standards-section).
• ARCP Program Page: [HSS Adult Residential Care Provider](https://ldh.la.gov/health-standards-section/hss-adult-residential-care-provider-arcp).
• Medicaid Fiscal Agent: [Gainwell Technologies](https://www.lamedicaid.com) (for general Medicaid reference, though not applicable to ARCPs).
• Statute Reference: [Louisiana State Legislature RS 40:2166.3](https://www.legis.la.gov/legis/Law.aspx?d=409893).

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