The short answer
Both are licensed residential treatment settings in Arizona. A BHIF (behavioral health inpatient facility) provides continuous treatment for people whose behavioral health issue limits their ability to meet their own basic physical needs. A BHRF (behavioral health residential facility) treats people whose behavioral health issue limits their independence, in a residential setting with 24-hour support but without a required on-site medical component.[1][2]
In the state's words
The licensing rules define the two side by side:
- A behavioral health residential facility is 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]
- A behavioral health inpatient facility is a health care institution that “provides continuous treatment to an individual experiencing a behavioral health issue that causes the individual to have a limited or reduced ability to meet the individual's basic physical needs,” among other criteria in the full definition.[1]
The key words are independence for a BHRF and continuous treatment and basic physical needs for a BHIF. A BHIF is the more intensive, more medical level of care.
The older names
Much of the confusion comes from the names changing. Arizona's Department of Child Safety notes in its field guide that BHRFs were formerly referred to as therapeutic group homes, and BHIFs as residential treatment centers.[2] Outside Arizona, those older names are still the usual ones, which is why a search for “therapeutic group home” or “residential treatment center” often means the same thing an Arizona provider would call a BHRF or a BHIF.
Four settings compared
BHRFs are also often confused with sober living homes and outpatient centers. Here are the four together, followed by two more settings that share the vocabulary.
| Setting | What it is | Treatment on site | Licensed under |
|---|---|---|---|
| Behavioral health residential facility (BHRF) | Residential treatment for people whose behavioral health issue limits their independence. | Yes. Treatment and 24-hour support; no on-site medical component is required. | ADHS, A.A.C. Title 9, Chapter 10, Article 7 |
| Behavioral health inpatient facility (BHIF) | Continuous treatment for people whose behavioral health issue limits their ability to meet their basic physical needs, among other criteria. | Yes. Structured treatment with 24-hour clinical support. | ADHS, A.A.C. Title 9, Chapter 10 |
| Outpatient treatment center | Diagnosis and treatment without inpatient beds. | Yes, but no one lives there. | ADHS, A.A.C. Title 9, Chapter 10 |
| Sober living home | A home for people in recovery that cannot provide behavioral health services, medical services, or medication administration on site. | No. | ADHS, A.A.C. Title 9, Chapter 12 |
BHRF vs sober living home
This distinction drew scrutiny during Arizona's Medicaid fraud crackdown. By statute, a sober living home does not include any premises licensed to provide on-site medical services, behavioral health services, or medication administration.[3] So a home where residents receive behavioral health services on site is not a sober living home under state law; that takes a health care institution license, such as a BHRF license. ADHS publishes a fact sheet comparing the two.[7]
BHRF vs outpatient treatment center
An outpatient treatment center has no inpatient beds.[1] It is also the class of institution that statute allows to open on a temporary license before its inspection, which a BHRF cannot do.[6]
BHRF vs adult behavioral health therapeutic home
An adult behavioral health therapeutic home is a residence that provides room and board and assists with self-administration of medication.[4] Unlike a BHRF, it does not have to meet the building code and zoning standards set for health care institutions.[5]
BHRF vs group homes for developmental disabilities
Group homes for people with developmental disabilities are a separate system, run by providers under contract with the Arizona Department of Economic Security. Statute defines, for example, a nursing-supported group home as a community residential setting for no more than six people with developmental disabilities, operated under a contract with that department.[4] A BHRF is a behavioral health license, even when the word “group home” is used for both.
Which setting fits
For young people in state care, the Department of Child Safety describes both BHRFs and BHIFs as treatment-focused and time-limited, appropriate only when outpatient services and lower levels of care do not meet the youth's clinical needs, and not to be used simply as a place to live.[2] Placement decisions are clinical ones made by the treatment team and, for Medicaid members, authorized by the health plan. The prior authorization section of our billing guide covers how that works for BHRFs.
If you are opening a BHRF, start with the licensing requirements.