Definitions.
Ark. Code Ann. § 20-10-1401
in effectAs used in this subchapter:
(1) "Average Direct Care Hours Per Resident Day" means the total number of hours of direct care services provided by direct care staff in a month, divided by the number of calendar days in that month and the facility's average daily resident census for that month;
(2) "Certified nursing facility" means a nursing facility licensed by the Department of Human Services that is certified to participate in the federal Medicare program as a skilled nursing facility or in the Arkansas Medicaid Program as a nursing facility, or both;
(3)(A) "Direct care services" means:
(i) Nursing and nursing-related services;
(ii) Clinical, diagnostic, therapeutic, and rehabilitative services;
(iii) Physical, occupational, respiratory, and speech therapy services;
(iv) Delegated physician tasks;
(v) Behavioral health services;
(vi) Care management, care coordination, and care transition activities;
(vii) Medication administration;
(viii) Assistance with activities of daily living;
(ix) Assessment, evaluation, planning, and implementation of care plans;
(x) Coordination and consultation with residents' physicians and other healthcare providers; and
(xi) Other services and supports provided for nursing facility residents in response to individual resident needs.
(B) "Direct care services" does not include food preparation, laundry, housekeeping, and other maintenance of a nursing facility's physical environment;
(4) "Direct care staff" means a person who provides any direct care services to a nursing facility resident through interpersonal contact with residents or resident care management, including without limitation:
(A) A licensed nurse;
(B) A nurse aide;
(C) A medication assistant;
(D) A physician;
(E) A physician assistant;
(F) A licensed physical or occupational therapist or licensed therapy assistant;
(G) A registered respiratory therapist;
(H) A licensed speech-language pathologist;
(I) An infection preventionist; and
(J) Other licensed or certified healthcare professionals;
(5) "Federal direct care data system" means the national online data reporting system operated by the Centers for Medicare and Medicaid Services and used by nursing facilities participating in the federal Medicare program or the Arkansas Medicaid Program, or both, to electronically report detailed and standardized direct care and other staffing information;
(6) "Licensed nurse" means any registered nurse, licensed practical nurse, advanced practice registered nurse, or registered nurse practitioner;
(7) "Medicare and Medicaid requirements of participation" means the federal requirements established by the Centers for Medicare and Medicaid Services under 42 U.S.C. 1320a-7j, 42 U.S.C. 1395i-3, and 42 U.S.C. 1396r, as existing on January 1, 2021, that a licensed nursing facility is required to follow to be certified as compliant with and participate in the federal Medicare program as a skilled nursing facility or the Arkansas Medicaid Program as a nursing facility, or both;
(8) "Medication assistant" means any medication assistive person who is qualified and certified under § 17-87-704;
(9) "Nurse aide" means any certified nurse aide or nurse aide in training consistent with federal and state nurse aide proficiency, training, education, and use requirements;
(10) "Nursing facility" means any entity licensed as a nursing facility by the department;
(11) "Nursing staff" means any licensed nurses, nurse aides, or medication assistants who are employed or contracted by a nursing facility; and
(12) "Private pay-only nursing facility" means a nursing facility licensed by the department that is not certified to participate in the federal Medicare program as a skilled nursing facility or in the Arkansas Medicaid Program as a nursing facility.
20-10-1402. Staffing standards.
(a) As a condition of licensure by the Department of Human Services, a nursing facility, except a private pay-only only nursing facility, shall:
(1)(A) Be certified to participate in the federal Medicare program as a skilled nursing facility or in the Arkansas Medicaid Program as a nursing facility, or in both.
(B) A certified nursing facility is subject to the Medicare and Medicaid requirements of participation, including without limitation federal requirements related to nursing and other direct care staffing, directors of nursing, daily information posting, and staffing data reporting through the federal direct care data system; and
(2) Provide each month direct care services by direct care staff equivalent to at least three and thirty-six hundredths (3.36) Average Direct Care Hours Per Resident Day.
(b)(1) On or before the fifteenth day of each month, a certified nursing facility shall report electronically to the department the certified nursing facility's actual Average Direct Care Hours Per Resident Day for the prior month.
(2) Hours used in determining actual Average Direct Care Hours Per Resident Day for each month shall be consistent with the certified nursing facility's final staffing data submission to the federal direct care data system for the applicable quarter and based on all direct care services labor categories and all direct care staff job codes.
(3) When necessary to correct monthly report data following quarterly data validation and based on the final staffing data reported in the federal direct care data system for the applicable quarter, a certified nursing facility shall promptly file an amended monthly report with the department.
(4) In the event of a public health emergency, natural disaster, other major emergency, or severe labor shortage, the department may temporarily waive the Average Direct Care Hours Per Resident Day requirements for any certified nursing facility or all certified nursing facilities in a county or state.
(5) The department may audit these reports and request documentation from the certified nursing facility to ensure compliance with the requirements of this section.
(c) As a condition of licensure by the department, a private pay-only nursing facility shall comply with all state requirements applicable to a private pay-only nursing facility, including rules promulgated by the department, and shall cooperate with the department audits, inspections, and document requests.
(d)(1) The department shall promulgate rules as necessary to carry out the provisions of this section.
(2) If the department promulgates rules, the rules shall:
(A) Apply to conditions and processes of state licensure;
(B) As applicable to a certified nursing facility, not exceed or duplicate Medicare and Medicaid requirements of participation, including staffing and data reporting requirements, except regarding Average Direct Care Hours Per Resident Day requirements;
(C) Not require permission, waivers, or otherwise restrict a nursing facility from engaging in staffing related practice permitted under Medicare and Medicaid requirements of participation, including without limitation:
(i) The engagement of services of direct care staff and other personnel on a full-time or part-time basis and through employment, contracting, and staffing agencies, or any combination thereof;
(ii) The use of fixed schedules, flex-time, rotating shifts, split shifts, compressed work weeks, and other alternative staffing schedules; and
(iii) The use of a universal worker model to assign nurse aides other tasks, such as food service, laundry, and housekeeping, in addition to direct care responsibilities with direct care and nondirect care hours appropriately differentiated; and
(D) As applicable to a private pay-only nursing facility, establish direct care services, staffing, and reporting requirements equivalent to those applicable to a certified nursing facility under this section or under Medicare and Medicaid requirements of participation.
(e) This section does not require or advise any specific or minimum number of nursing staff hours, direct care staff hours, or hours of other services for any nursing facility resident.
Source: Arkansas General Assembly, Acts of 2021-2026 (arkleg.state.ar.us)URL: https://arkleg.state.ar.us/Acts/FTPDocument?path=%2FACTS%2F2021R%2FPublic%2F&file=715.pdf&ddBienniumSession=2021%2F2021RFetched: 11/8/2026