A certificate of need (CON) is a legal document that healthcare providers in some states must obtain before building, expanding, or changing a facility or the services they offer. In Arkansas, certificate of need regulations cover certain categories of healthcare facilities and services, including nursing homes, inpatient psychiatric facilities, and home health services.
Arkansas' CON program is intended to support an equal distribution of care and cost containment. These are both urgent issues due to the large portion of the population living in underserved areas, and medical-debt rates that are higher than the national average.
Following renewal of the program in 1987, application and review is also referred to as the Permit of Approval (POA) process. If you're planning to open a new healthcare facility in Arkansas or make changes to an existing one, you may need to obtain approval from the state. Let's go over the essential information including the relevant laws, the agencies involved, and the steps for applying.
Arkansas Certificate of Need Laws at a Glance
Expanding or altering your healthcare practice may necessitate a certificate of need. Arkansas' approval process is based on key laws and rules, and involves a population-based approach to determining need. We gathered the essential information into one chart to help you navigate the process.
| Arkansas Certificate of Need Summary | |
|---|---|
| Legal Authorities | Arkansas Code Annotated, Title 20, Subtitle 2, Chapter 8, Subchapter 1:Sections20-8-101 to 20-8-113Code of Arkansas Rules, Title 20, Chapter 3, Subchapter A, Part 255:Rule20-CAR-255-101 to 20-CAR-255-801 |
| Covered Entities, Services, or Actions | The Arkansas Health Services Permit Agency (AHSPA), under the guidance of the Health Services Permit Commission (HSPC), oversees the permit process fordesignated categories of facilities(as defined inSection 20-10-101andSection 20-10-801) that are undergoing construction, expansion, or alteration, including:Nursing facilitiesResidential care facilitiesAssisted living facilitiesHome health agenciesHospice agenciesPsychiatric residential care facilitiesIntermediate care facilities for the intellectually disabledIn addition, AHSPA regulates certain activities related to those facilities, including:Transferring long-term care beds from one facility to another.Changing the site location of an approved project.Transfering a POA to another provider/entity.Certain types of facilities maynotrequire an Arkansas certificate of need, such as:Hospitals (with exceptions)Physician offices (with exceptions)Outpatient surgery centersImaging centersFacilities that exclusively use prayer/religious means for healingIn certain situations, a facility that falls under the scope of regulations may be exempt from the process, such as:Facilities in underserved areas.Facilities offering certain categories of services. |
| Establishment of Need | Reviewers will assess proposals based on the community’s needs, such as access to quality care, with a focus on equitable distribution of providers.Applicants canestablish a needfor a health facility by demonstrating that the proposal:Will benefit the service area’s healthcare system.Will improve efficiency or productivity of healthcare delivery in the service area.Will reduce cost or demand for a healthcare service in the community, or reduce state or federal costs.Is necessary to meet the healthcare demands of the service area according to an analysis of demographic data and projected healthcare needs.Meets the standards outlined in AHSPA’s annually published bed needs book. |
| Duration of Process | The Arkansas certificate of need process takes place according to 4 annual review cycles and can take up to4 months, including a 30-day period for verifying completion of an application and90 daysfor a review. |
| Enforcement Agency | Health Services Permit Agency |
| Fees | The fee for applying for a CON in Arkansas is $3,000. |
| Application Forms | The Arkansas certificate of need application and review process involves scheduling a pre-submission conference with an AHSPA staff member (recommended), submission of an application form, and a review.The required application forms vary depending on the category of facility and the phase of the project. |
| Penalties | Entities or providers that fail to comply with Arkansas’ CON regulations may facemonetary fines. |
The Development of Certificate of Need: Arkansas' History of Public Health Planning
Arkansas first implemented a certificate of need program in 1975, following the federal National Health Planning and Resources Development Act of 1974, which restructured the country's health planning systems and authorized federal funding for states with CON programs.
Initially, the State Health Planning and Development Agency was responsible for evaluating applications for an Arkansas certificate of need. Hospitals and healthcare facilities fell under the regulations, along with a broad range of activities such as offering new services and changing license classifications.
In 1987 the federal government repealed its CON program mandate, and many states across the nation evaluated their existing programs and decided to make policy changes. Arkansas' certificate of need laws were repealed, and new regulations and program leadership took shape. The updated laws and rules established a narrower scope of oversight, with long-term care facilities requiring approval and other types of facilities (such as hospitals and ambulatory surgery centers) gaining more freedom.
A Population-Based Approach to Determine Need
In their reinstated form, Arkansas' certificate of need laws are intended to control healthcare costs and promote adequate distribution of some types of healthcare services throughout the state. In an effort to facilitate this, AHSPA uses a methodical, population-based approach for determining the healthcare needs of each county. The details of the method can be found within the Code of Arkansas Rules.
For example, a provider requesting to add beds to a psychiatric residential treatment facility could use the bed need formula described in 20-CAR-255-602to demonstrate need. If the calculations fail to show a need, the applicant may be able to use other means to show that the new beds are necessary, such as proving that existing psychiatric facilities aren't adequately meeting the needs of the community.
More Tips for the Arkansas Permit of Approval Process
Once you've performed the necessary analysis and submitted your application, AHSPA will check that your application is complete and post a public notice that your proposal is under review. Any opponents to your project will have 30 days to submit comments, and applicants have an additional 20 days to issue a response. It may be helpful to prepare for this segment of the review process in advance by gathering additional data that supports the need for your project.
Get the Critical Information You Need for Growth
Obtaining your Arkansas certificate of need will be a rewarding step in your path to bringing better healthcare to your area, but we know that navigating growth is challenging. Get the answers you need, when you need them, with our wide range of facility guides and resources.
Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.