What a BHRF is
A behavioral health residential facility (BHRF) is a class of health care institution licensed by the Arizona Department of Health Services (ADHS). The rules define it as a health care institution that “provides treatment to an individual experiencing a behavioral health issue that limits the individual's ability to be independent or causes the individual to require treatment to maintain or enhance independence.”[1]
In statute it falls under the wider term “residential care institution”: a health care institution, other than a hospital or nursing care institution, that provides resident beds and services such as behavioral health services to people who do not need continuous nursing care.[2] That distinction from a facility providing continuous, inpatient-level treatment is what separates a BHRF from a BHIF. The BHRF vs BHIF guide covers the differences in full.
You may also hear BHRFs called therapeutic group homes, especially in youth placements: Arizona's Department of Child Safety notes that BHRFs were formerly referred to as therapeutic group homes.[15]
Which rules apply
Two layers of law govern a BHRF. The statutes in Arizona Revised Statutes Title 36, Chapter 4 set up licensing for all health care institutions. The detailed rules are in the Arizona Administrative Code, Title 9, Chapter 10: Article 1 applies to every health care institution, and Article 7 is written for BHRFs.[1] This guide reflects the chapter as published in Supplement 26-1 (March 31, 2026).
Article 7, section by section:
| Section | Covers |
|---|---|
| R9-10-702 | Supplemental application and documentation |
| R9-10-703 | Administration |
| R9-10-704 | Quality management |
| R9-10-705 | Contracted services |
| R9-10-706 | Personnel |
| R9-10-707 | Admission; assessment |
| R9-10-708 | Treatment plan |
| R9-10-709 | Discharge |
| R9-10-710 | Transport; transfer |
| R9-10-711 | Resident rights |
| R9-10-712 | Medical records |
| R9-10-713 | Transportation; resident outings |
| R9-10-714 | Resident time-out |
| R9-10-715 | Physical health services |
| R9-10-716 | Behavioral health services |
| R9-10-717 | Outdoor behavioral health care programs |
| R9-10-718 | Medication services |
| R9-10-719 | Food services |
| R9-10-720 | Emergency and safety standards |
| R9-10-721 | Environmental standards |
| R9-10-722 | Physical plant standards |
If you will bill Medicaid, AHCCCS adds its own requirements on top of the license, chiefly AHCCCS Medical Policy Manual policy 320-V.[13] Those are covered in the BHRF billing guide.
Getting licensed, step by step
1. Decide who you will serve
The BHRF application asks whether you will serve residents under 18, adults, or both, and whether you will provide respite, court-ordered evaluation or treatment, or personal care services.[1] Those answers shape the rest of your policies, staffing, and building.
2. Settle the building and zoning first
A health care institution has to meet local codes and ordinances, and the license application includes a notarized attestation from an architect that the plans and specifications meet or exceed the department's standards.[3] Check local zoning before you sign a lease. The state-level protection that treats small homes as single-family residences, A.R.S. 36-582, is written for homes serving people with developmental disabilities under the state's developmental disabilities program, not for BHRFs.[9]
3. Apply to ADHS 60 to 120 days before opening
The application goes in at least 60 and no more than 120 days before the date you expect to open, and names the controlling persons, the chief administrative officer, the class of institution, and the services you will provide. Changes in controlling persons are reported within 30 days.[4] Application and license fees are set in rule and scale with licensed capacity.[1]
4. Pass the initial inspection
ADHS inspects once it has a complete application, and issues the license after the inspection and payment of the fee.[5] A BHRF cannot open on a temporary license ahead of that inspection; the statute reserves that option for outpatient treatment centers.[4]
5. Keep the license current
An Arizona health care institution license does not expire. It stays valid unless it is revoked or suspended, or becomes void for unpaid fees or penalties.[5]
6. To bill Medicaid, enroll with AHCCCS
A license lets you operate; it does not let you bill AHCCCS. BHRFs enroll as provider type B8, which AHCCCS screens as high risk: since May 29, 2023 that has meant an application fee, a fingerprint-based criminal background check, and a site visit at enrollment and revalidation.[11] The enrollment moratorium AHCCCS placed on new BHRFs in 2023 ended on December 9, 2024.[12]
Staff requirements
- Fingerprint clearance. Staff, owners, contractors, and volunteers who provide behavioral health or direct services must hold a valid fingerprint clearance card or apply for one within 20 working days of starting.[6]
- Adult Protective Services registry. Since January 1, 2025, facilities check the APS registry before hiring and recheck staff every year.[6]
- First aid and CPR training specific to the populations served.[1]
- Tuberculosis screening for anyone with more than eight hours a week of direct interaction with residents.[1]
- Who is on site. Enough staff to meet each resident's needs, at least one staff member present and awake whenever a resident is on the premises, and a behavioral health professional present or on call.[1]
Each of these leaves a document behind, and surveyors ask to see them. A personnel file that holds the clearance card, training certificates, and screening results for every staff member, with expiry dates tracked, is the simplest way to be ready.
Assessment, treatment plan, and discharge deadlines
These clocks are where documentation most often falls behind. The treatment plan rule is one of the deficiencies ADHS highlights in its training on the ten it cites most often in BHRFs.[10]
| What | Deadline | Rule |
|---|---|---|
| Behavioral health assessment | Completed before treatment begins. If a behavioral health technician or registered nurse completes it, a behavioral health professional reviews and signs it within 24 hours. Documented in the record within 48 hours of completion. | R9-10-707[1] |
| Medical history and physical examination | Within 30 calendar days before admission or 7 calendar days after it. | R9-10-707[1] |
| Treatment plan | Before the resident receives services, or within 48 hours after the assessment is completed. A plan completed by a behavioral health technician is reviewed and signed by a behavioral health professional within 24 hours. | R9-10-708[10] |
| Treatment plan updates | On or before the review date in the plan, when a goal is met or changed, when new information changes the assessment, and when the resident's condition changes significantly. | R9-10-708[1] |
| Discharge plan | Completed before discharge and documented within 48 hours after it is completed. | R9-10-709[1] |
| Discharge summary | Entered within 10 working days after the resident leaves. | R9-10-709[1] |
AHCCCS layers its own expectations on top for Medicaid members. Its BHRF policy has required the treatment team to meet and review the plan with the member at least once a month, and discharge planning to start at admission.[13] That policy was revised effective October 1, 2026, so check the current text.
Medical records
Entries must be dated, legible, and authenticated.[1] Records are kept for the periods in A.R.S. 12-2297: for an adult, at least six years after the last date of service; for a child, until three years after the child's eighteenth birthday or six years after the last date of service, whichever is later.[7]
For how to write the daily entries that make up most of a BHRF record, see how to write group home shift notes.
Drills, food, and the building
- Disaster drills for staff on each shift at least once every three months, and evacuation drills for staff and residents at least once every six months on each shift, each documented with the date, time, participants, problems found, and recommendations.[1]
- Menus prepared at least a week in advance and posted at least a day before.[1]
- Bathrooms: one working toilet and sink for every six residents who stay overnight, and one bathtub or shower for every eight.[1]
- Bedrooms: at least 60 square feet per occupant in a shared bedroom, not counting the closet.[1]
Inspections and penalties
ADHS inspects health care institutions for compliance at least once a year. Since 2024, residential care institutions, which include BHRFs, are not eligible to skip an inspection cycle after a deficiency-free survey.[5][14]
Civil penalties can reach $1,000 per violation, may be assessed for each resident affected, and each day a violation continues counts as a separate violation.[8]
Opening checklist
- Decide the population (under 18, adults, or both) and the services you will offer.
- Confirm local zoning and building requirements for the property.
- Have an architect prepare plans and the notarized attestation.
- Write policies and procedures covering each Article 7 section.
- Hire staff; start fingerprint clearance and APS registry checks; complete CPR, first aid, and TB screening.
- Submit the ADHS application 60 to 120 days before opening.
- Pass the initial inspection and pay the license fee.
- Enroll with AHCCCS as provider type B8 and complete high-risk screening, if you will bill Medicaid.
- Set up records so assessments, treatment plans, shift notes, and drills are documented from the first admission.
Dacnus, software for Arizona BHRFs, was first built and proven inside a licensed Arizona residential program. It keeps treatment plans, shift notes, staff credentials and training, and the audit trail of who documented what on one record.