Arkansas

Arkansas

Arkansas maintains a CON program, which it calls a “permit-of-approval” (POA) program, within four broad categories—hospital beds, beds outside hospitals, facilities and services. POAs function the same as CONs. Arkansas also maintains four moratoria on: (1) adding beds at residential care facilities; (2) adding beds at psychiatric residential treatment facilities; (3) opening new residential care facilities with more than 16 beds; and (4) opening intermediate care facilities for the mentally disabled. The state’s POA program sometimes treats similar facilities very differently. For example, opening a new assisted living or hospice facility requires a POA, but opening a new nursing home does not. A POA is required, however, to renovate a nursing home, but only when the renovations will cost more than $1 million. Assisted living and hospice facilities have no similar POA requirement for renovations.

COVID-19 Response

As of May 15, 2020, Arkansas had not suspended any POA requirements in response to COVID-19. The Department of Health, however, clarified that existing regulations allow hospitals to increase bed capacity in response to an emergency. Arkansas also maintains a rule allowing hospice facilities to temporarily expand during an emergency. See Ark. Health Servs. Permit Agency,
Permit of Approval Rulebook, 31 (Dec. 2012).

Application Process

In Arkansas, the POA application process takes approximately 90 days. Ark. Code R. § 20-8-104(c). Applications can be submitted at any time but are reviewed in four cycles per year. The fee for a POA application is $3,000. Permit of Approval Rulebook at 13–14. Competitors can intervene in the application process and can offer evidence or argument as to why an application should be denied. Ark. Code R. § 20-8-106(d), (e).

CON? Number of CONs Moratoria Temporary COVID-19 response:
Hospital Beds Yes 2 – Preexisting regulations
Beds Outside Hospitals Yes 7 2 Preexisting regulations
Equipment No – – –
Facilities/ Buildings Yes 3 2 No action
Services Yes 8 – No action
Emergency Medical Transport No – – –

Note: these citations are accurate as of May 2020.

Arkansas POAs in Detail

Category Moratoria/Types of POAs Ark. Code R.
Hospital Beds 1.Adding new beds or expanding existing long-term bed capacity. § 20-8-107(a)
2.Converting acute care beds to long-term care beds or allowing their license classification to be changed to long-term care beds. §§ 20-8-107(a), 20-8-106(b)(1)(B)
Beds Outside Hospitals 1.Moratorium on adding new beds or expanding capacity of residential care facilities. § 20-8-107(d)
2.Moratorium on beds for Psychiatric Residential Treament Facilities. Permit of Approval Rulebook at 42
Adding new beds or expanding existing long-term bed capacity at a:

3.Residential care facility.

4.Nursing home.

5.Assisted living facility.

6.Post-acute head injury retraining facility and residential care facility.

7.Any other facility which provides long-term medical or personal care.

 §§ 20-8-107(a),

20-8-101(6)(A), 20-10-101(10)(A)
8.Adding new beds or expanding existing long-term bed capacity at a home health services agency. §§ 20-8-107(a),

20-8-101(6)(A), 20-10-801(6)
9.Adding new beds or expanding existing long-term bed capacity at hospice facilities and hospice agencies. § 20-8-107(a)(1)
Equipment No CONs in this category.  
Category Moratoria/Types of POAs Ark. Code R.
Facilities/Buildings 1.Moratorium on new or replacement residential care facilities, with exceptions for facilities with 16 beds or fewer. § 20-8-106(a)(3)(B), (C)
2. Moratorium on intermediate care facilities for the mentally retarded. Permit of Approval Rulebook at 46
1.Nursing home alteration or renovation having an associated capital expenditure of more than $1 million. § 20-8-106(b)(1)(A)
2.Assisted living facilities. §§ 20-10-1709(a),

20-10-101(10)(A)
3.Hospice facilities. § 20-7-117(c)(1)
Services 1.Adding new or expanding existing home health services offered by a hospital. § 20-8-107(a)
2.Adding new or expanding existing home health services offered by a nursing home. §§ 20-8-107(a),

20-8-101(6)(A),

20-10-101(10)(A)
3.Adding new or expanding existing home health services offered by a residential care facility.
4.Adding new or expanding existing home health services offered by an assisted living facility.
5.Adding new or expanding existing home health services offered by a post-acute head injury retraining facility and residential care facility.
6.Adding new or expanding existing home health services offered by any other facility which provides long-term medical or personal care.
7.Adding new or expanding existing home health services offered by home healthcare services agency. §§ 20-8-107(a),

20-8-101(6)(A),

20-10-801(6)
8.Hospice services. § 20-7-117(c)(1)
Emergency Medical Transport No CONs in this category.  

Arkansas POA Exceptions

No POA Required For:

Ark. Code R.

1.A hospital, except when adding long-term care beds or converting acute beds to long-term care beds or to add or expand home health services pursuant to a letter of intent filed with the Department of Health.

§ 20-8-101(6)(B)(i)

2.Projects proposed for the construction, expansion or alteration by or on the behalf of a nursing home, which have an associated capital expenditure of less than $1 million and do not add long term care beds or home health services.

§ 20-8-106(b)(1)(A)

3.Religious facilities.

§ 20-8-101(6)(B)(viii)

4.Outpatient surgery centers and imaging centers.

§ 20-8-101(6)(B)(iii)

5.Freestanding radiation therapy centers.

§ 20-8-101(6)(B)(v)

6.Residences for four or fewer individuals with developmental disabilities who receive support and services from nonprofit providers currently licensed by the Division of Developmental Disabilities Services.

§ 20-8-101(6)(B)(vii)

7.Expansion, not to exceed 15 beds, of the 25-bed nonprofit intermediate care facility for individuals with developmental disabilities that provides transitional rehabilitation for pediatric patients.

§ 20-8-101(6)(B)(vi)

8.Offices of private physicians and surgeons.

§ 20-8-101(6)(B)(ii)

9.Post-acute head injury retraining and residential care facilities or establishments operated by the U.S. government or any agency thereof.

§ 20-8-101(6)(B)(iv)

10. Any bed or facility used to provide care to delinquent juveniles committed into the care of the Division of Youth Services.

§§ 20-8-101(6)(B)(ix),

20-8-113(6)

11. Facilities offering head injury retraining and rehabilitation.

§ 20-10-103(a)

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