DELIVERING SKILLED, LONG-TERM CARE SERVICES FOR INDIVIDUALS WITH COMPLEX MEDICAL NEEDS
Nursing Facility (NF) Services in Arizona provide 24-hour skilled nursing care, rehabilitation, and assistance with daily living activities for individuals who have complex health conditions and require a higher level of care than can be provided in home or community settings. These services are authorized under Arizona’s Medicaid Long-Term Care system and are designed to support individuals who meet nursing facility level-of-care criteria.
1. GOVERNING AGENCIES
Agency: Arizona Department of Health Services (ADHS) – Division of Licensing Services
Role: Licenses Nursing Facilities and ensures compliance with state health and safety standards
Agency: Arizona Health Care Cost Containment System (AHCCCS)
Role: Manages Medicaid enrollment, reimbursement, and oversight for Nursing Facility services
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight of Medicaid and Medicare certification for Nursing Facilities and ensures compliance with federal regulations
2. NURSING FACILITY SERVICE OVERVIEW
Nursing Facilities offer long-term residential care with access to professional medical and personal support services, available 24/7.
Approved providers may deliver:
- Skilled nursing care (RN or LPN services)
- Administration of prescribed medications and treatments
- Physical, occupational, and speech therapy services
- Health monitoring and chronic disease management
- Assistance with Activities of Daily Living (ADLs) such as bathing, toileting, eating, and mobility
- Nutritional services, meal planning, and therapeutic diets
- Social services coordination and discharge planning
- Recreational and therapeutic activities
- Hospice coordination services if needed
All services must be delivered according to individualized care plans and in compliance with Medicaid and Medicare standards.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
- Register business entity with the Arizona Corporation Commission
- Obtain EIN from the IRS and NPI (Type 2)
- Obtain a Nursing Care Institution License from ADHS
- Meet CMS certification requirements (for facilities seeking Medicaid and Medicare reimbursement)
- Maintain liability insurance and meet minimum staffing ratio requirements
- Develop comprehensive policies for nursing services, emergency preparedness, infection control, and resident rights
4. AHCCCS PROVIDER ENROLLMENT PROCESS
Initial Interest and Application:
- Request Medicaid Nursing Facility enrollment packet from AHCCCS
- Attend any required AHCCCS or Managed Care Organization (MCO) training sessions
Application and Documentation Submission:
- Submit proof of licensure, staffing plans, facility operating procedures, and CMS survey results (if certified)
- Provide sample resident service agreements, emergency procedures, and care plans
- Submit staff credentialing documentation, background checks, and insurance policies
Program Readiness Review:
- AHCCCS and/or MCOs review facility readiness, staffing qualifications, service delivery models, and compliance with care standards
- Facility inspections and audits may be conducted before final approval
Approval & Medicaid Enrollment:
- After approval, contract with AHCCCS and/or Medicaid Managed Care Organizations serving ALTCS members
- Finalize billing setup and Medicaid claims system configuration
5. REQUIRED DOCUMENTATION
- Articles of Incorporation or Business License
- IRS EIN confirmation
- NPI confirmation
- Nursing Care Institution License from ADHS
- CMS Certification of Participation (if applicable)
- Liability insurance coverage documentation
Policy & Procedure Manual including:
- Admission and discharge processes
- Person-centered care planning protocols
- Medication administration and skilled nursing service procedures
- Resident rights and grievance resolution processes
- Emergency preparedness and fire safety protocols
- Staff background checks, training records, and annual competency reviews
- Incident reporting, infection control, and quality assurance programs
- Medicaid and Medicare billing, documentation, and authorization tracking systems
6. STAFFING REQUIREMENTS
Role: Nursing Facility Administrator
Requirements: Active Arizona Nursing Care Institution Administrator License, background check clearance, experience managing long-term care operations
Role: Director of Nursing (DON)
Requirements: Active Arizona Registered Nurse (RN) license, supervisory experience in skilled nursing facilities
Role: Licensed Nurses (RNs/LPNs) and Certified Nursing Assistants (CNAs)
Requirements: Arizona licensure/certification, CPR certification, background check clearance
All staff must complete:
- Initial and annual resident rights, abuse prevention, and confidentiality training
- Infection control and emergency preparedness training
- Clinical skills assessments and ongoing competency evaluations
7. MEDICAID WAIVER SERVICES
While Nursing Facility services fall primarily under the Arizona Long Term Care System (ALTCS) rather than traditional HCBS waivers, services are covered under these programs:
- ALTCS – Elderly and Physically Disabled (EPD) Program
- ALTCS – Developmental Disabilities (DD) Program (when nursing facility level of care is appropriate)
Approved Nursing Facilities may deliver:
- 24/7 skilled nursing and personal care services
- Therapy services to support rehabilitation and functional improvement
- Care coordination with ALTCS case managers and medical teams
- Transitional care planning when residents can return to less restrictive settings
8. TIMELINE TO LAUNCH
Phase: Business Formation and Licensing Setup
Timeline: 2–4 weeks
Phase: Facility Readiness and CMS Certification Survey (if seeking certification)
Timeline: 90–180 days
Phase: Staff Hiring, Training, and Facility Systems Setup
Timeline: 60–90 days
Phase: AHCCCS Enrollment and MCO Contracting
Timeline: 60–90 days
9. CONTACT INFORMATION
Arizona Department of Health Services – Division of Licensing Services
Website: https://www.azdhs.gov/licensing/
Arizona Health Care Cost Containment System (AHCCCS)
Website: https://www.azahcccs.gov/
Arizona Medicaid Provider Enrollment Portal
Website: https://www.azahcccs.gov/PlansProviders/NewProviders/
Centers for Medicare & Medicaid Services (CMS) Nursing Home Provider Enrollment
Website: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/NHs
10. SCOPE OF WORK
- Business registration and EIN/NPI setup
- ADHS licensing guidance and CMS certification preparation
- AHCCCS provider enrollment and MCO contracting assistance
- Development of Nursing Facility Policy & Procedure Manual
- Staff credentialing and training system setup
- Medicaid and Medicare claims system configuration
- Website, domain, and email setup
- Resident admission and discharge packet creation
- Emergency preparedness and quality assurance program templates
- Referral networking and healthcare partnership development strategies
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — ARIZONA NURSING FACILITY PROVIDER
We support healthcare entrepreneurs and facility owners in establishing Medicaid- and Medicare-compliant Nursing Facilities under Arizona’s ALTCS program.
To get started, click the link to request portal access.