Arkansas Certificate of Need (CON) Program

Arkansas Permit of Approval (POA) Introduction

Arkansas has an extensive Permit of Approval (POA) process in place for healthcare services and facilities. Winning approval for a POA application is often a time consuming and difficult undertaking. Working with RPC provides clients with a team of consultants with experience working to develop state applications for new health services.

When working on a POA project, RPC can prepare the entire POA application or sections of the application as the client prefers. When the client is defining the project and deciding whether to file an application, RPC can help assess the market and regulatory situation to determine the relative likelihood of success for a project. RPC not only works to create a thorough market, need and financial analysis, but also works seamlessly with the client’s staff, architects, engineers and, other outside consultants to create a solid POA application.

RPC is led by Ron Luke, JD, PhD, who has prepared applications for health care facilities and services and presented testimony in related hearings since 1981 in more than 20 states.  RPC’s work on these projects includes the opening of new acute care hospitals, hospices, physical rehabilitation and psychiatric specialty hospitals, nursing homes, the relocation and addition of beds, and the acquisition of major medical equipment. Working with RPC during the POA process gives the applicant the advantage of a skilled expert team that can provide expert advice and produce an effective POA application.

Contents last updated in July 2024

State Agencies

Arkansas Health Services Permit Agency
“The Health Services Permit Agency, with direction from a nine member Health Services Permit Commission, is responsible for issuing Permits of Approval (POAs) for Nursing Facilities, Residential Care Facilities, Assisted Living Facilities, Home Health and Hospice Agencies, Psychiatric Residential Care Facilities and Intermediate Care Facilities for the Intellectually Disabled.” (https://ahspa.arkansas.gov/)

Arkansas Health Services Permit Agency
Mosaic Templars State Temple
906 Broadway, Suite 200
Little Rock, AR 72201
(501) 661-2509

Services that Require POA

Permits of Approval are issued to individuals, organizations, and facilities authorizing projects for a specific service area and range of services. Certain projects are exempt from review or entitled to expedited review.  Projects requiring POA include, but are not limited to, the following:

• Nursing Home Construction
  All proposals for conversion of services, alteration, renovation, or construction with a capital expenditure of $1,000,000 or more.

• Additional Beds
  Proposals seeking to add new Long Term Care (LTC) beds or expand LTC bed capacity.

Long term care facility is defined as: nursing home, residential care facility, post-acute head injury retraining and residential care facility, and any other facility which provides long-term medical or personal care.

• Home Health Services
  Proposals seeking to add home health services or expand service areas (includes changes in license designation).

• Hospice
  All hospices or hospice programs

• Cost Overrun
  Any increase in cost in an approved project for renovation, construction, or alteration of a health facility is deemed a cost overrun and must be documented and filed with the agency.

Projects Requiring Approval by the Commission:

• Movement of Existing LTC beds from one site to another
• Movement of Site Location of Permit of Approval
• Transfer of Permit of Approval, legal title, or right of ownership

Permit of Approval Process Milestones

For a regular review, the applicant follows the process described below.

1. Pre-application conference
   If needed, the applicant may request a meeting with an Agency representative to provide guidance in developing the application.
2. Submit application and Appropriate Review Fee
   Applications may be submitted in batches occurring 4 times per year on February 1, May 1, August 1, or November 1.  The appropriate forms must be obtained from the Agency. Information requirements vary depending on the type of reviews and project.  Applicants must submit an original and one copy of a completed application to the Agency. The application must be signed with blue ink and submitted before 4:30 pm on the due date. Applicants must also submit a review fee of $3,000 at the time of the application.
3. Determination of completeness
   Within 30 days of submission, the Agency will send notice of completeness.  The applicant has 15 days to send additional requested information to the Agency. An applicant may correct a mistake in an application within the first 30 days after the application is under review if no other application in the review cycle is considered competitive or if the change does not affect the scope of the proposal.
4. Beginning of review period
   Notification, along with a proposed review schedule, is published in the newspapers and sent to the applicant and all affected persons.  The review period lasts 90 days, beginning when the application is deemed complete and submitted for review to the Agency.  During the review period, the Agency makes all application and written materials accessible to the general public.
5. Opponents’ written comments
   Opponents have 30 days from the beginning of the review cycle to submit comments to the Agency.  Applicants have until the 50th day of the review cycle to respond in writing to the comments.
6. Informal hearing
   The Director of the Agency has the authority to organize an informal hearing on any application.
7. Agency decision
   The agency makes written findings and renders a decision by the 90th day of the review cycle.
8. Commission appeal hearing
   Applicants may file for appeal within 30 days of receipt of the decision.  Opponents who submitted letters of opposition during the review period are also eligible to request an appeal hearing.  Appellants and appellees have the opportunity to present witnesses and cross-examine at a hearing within 90 days of the agency’s decision.  Each side is limited to 60 minutes (including opening and closing).  Within 15 days of the close of the hearing, the agency renders a final decision.
9. Progress reports
   The applicant must keep the agency informed during its approval period.  Progress reports are required at the time the construction contract is due, at the time the foundation is completed and every 6 months until licensure.

What criteria are used to review a POA?

There are specific criteria, restrictions, and bed need methodologies for Assisted Living, Home Health, Hospice, Nursing Home, Psychiatric Residential Treatment, and Residential Care Facilities/Services. Generally, the Agency and the Commission use the criteria below to review POAs.

• Need or projected need for the proposed project in the locale or area
• Ability of the project to be adequately staffed and operated when completed
• Economic feasibility
• Ability to foster cost containment through improved efficiency and productivity

Permit of Approval Application Filing Fee

The review fee is $3,000 for all reviews.  If the applicant requests a hearing, prevailing agency costs per page will be charged.

Additional Sources

(links good as of January 2024)

Arkansas Health Services Permit Agency
https://ahspa.arkansas.gov /

POA Rules
https://www.healthy.arkansas.gov/rules-and-regulations

Bed Need Publication
https://www.healthy.arkansas.gov/images/uploads/pdf/Bed_Need_Book.pdf

POA Application Forms
https://www.healthy.arkansas.gov/programs-services/topics/arkansas-health-services-permit-agency

POA Rule Book updated on December 2012
http://www.arhspa.org/rules_regs/RulebookDecember2012.pdf