Full Opinion

Cite as 2026 Ark. App. 532 ARKANSAS COURT OF APPEALS DIVISION IV No. CV-25-375 STEP BY STEP HEALTH, INC. Opinion Delivered November 4, 2026 APPELLANT APPEAL FROM THE PULASKI COUNTY CIRCUIT COURT, SIXTH V. DIVISION [NO. 60CV-24-9142] ARKANSAS HEALTH SERVICES PERMIT AGENCY HONORABLE TIMOTHY DAVIS FOX, APPELLEE JUDGE AFFIRMED ROBERT J. GLADWIN, Judge Appellant Step by Step Health, Inc. (“Step”), appeals the Pulaski County Circuit Court’s order affirming the Arkansas Health Services Permit Commission’s (the “Commission’s”) denial of its application for a permit of approval for a home-health-agency license, which had been approved by the Arkansas Health Services Permit Agency (the “Agency”). On appeal, Step argues that the Commission failed to timely issue its ruling denying the permit; therefore, a permit was granted as a function of law. Additionally, Step maintains that the record clearly established that the home-health needs of the citizens of Faulkner County are not being met; thus, the circuit court’s order affirming the decision should be reversed. We affirm. I. Background Facts Phyllis Green is the owner of Step, which is a corporation seeking to provide home- health-care services to residents of Faulkner County, Arkansas. On October 31, 2023, Ms. Green applied for a permit of approval for a home-health agency class “A” license to serve Faulkner County. The Arkansas Rules for Home Health Agencies sets forth a population-based methodology for determining whether a need exists in a particular area. 20 CAR § 255- 301(a) (Oct. 26, 2026). If the methodology does not show a need, an approval may still be granted if the applicant offers documentation to prove that existing agencies are not meeting the needs of the service area population. Id. § 255-301(b). Step applied for the exception to the population-based methodology. At the time Step applied, the need demonstrated—based on population—was negative eight. In its application, Step proposed that it would provide advance practice registered nurses (APRNs) to serve the “growing community of home bound residents of Faulkner County.” Step asserted that no home-health agency in the county was providing APRN home-visit services as evidenced by a survey it conducted on the agencies serving Faulkner County. During the application-review process, the Agency received five letters opposing Step’s application. All opposition letters argued that there was no need for another home- health agency in Faulkner County and that Step should not be granted an exception because it failed to submit evidence of an unmet need for home-health services in the county. The Agency determined that Step had failed to fulfill the need requirement under the 2 population-based methodology; however, the Agency granted Step’s application because it found that Step met its burden of proving entitlement to the permit under the unmet-needs exception. Accordingly, on February 26, 2024, the Agency granted Step a permit of approval to provide home-health services from an office in Conway, Arkansas. Care IV, Inc., d/b/a Care IV Home Health (“Care IV”); Elite Home Health; and Thrive Pediatric Nursing, Inc., appealed the Agency’s decision to grant the permit to Step on the basis of the exception. On September 19, 2024, an administrative hearing was held before the Commission. The Commission heard testimony from Steven Hammond, vice president of Care IV, and Kelly Flowers, vice president of operations with Elite Home Health, both of whom testified that Step’s application failed to demonstrate that the current home-health-care agencies were not meeting the needs of Faulkner County. In response, Ms. Green testified that Step would provide APRN services to homebound patients, and because no other current home-health- care service providers were providing APRN services, Step would provide these services to meet the unmet needs of the service-area population. After hearing the evidence and testimony, the Commission held that Faulkner County was not in need of additional home-health agencies and that Step did not qualify for the exception to the methodology. The Commission announced its decision—that Step failed to meet the requirement for the permit under the unmet-needs. exception—on the record and with all parties in attendance. On October 14, 2024, the Commission’s decision was reduced to writing. Accordingly, Step filed a petition for judicial review in the Pulaski County Circuit Court pursuant to the Administrative Procedure Act. On April 3, 2025, the 3 circuit court entered an order affirming the Commission’s decision. Step filed a timely notice of appeal; this appeal followed. II. Standard of Review This court may reverse or modify an agency decision if the substantial rights of the petitioner have been prejudiced because the administrative findings, inferences, conclusions, or decisions are, inter alia, not supported by substantial evidence of record or are arbitrary, capricious, or characterized by an abuse of discretion. Ark. Code Ann. § 25-15-212(h)(5) and (6) (Repl. 2024). Our review is not directed toward the circuit court but toward the decision of the agency. Ark. Dep’t of Hum. Servs. v. Kistler, 320 Ark. 501, 898 S.W.2d 32 (1995); Ark. Bd. of Registration for Prof’l Geologists v. Ackley, 64 Ark. App. 325, 984 S.W.2d 67 (1998). Furthermore, we review the entire record to determine whether substantial evidence supports the agency’s decision and whether it is arbitrary or capricious. Wacaser v. Ins. Comm’r, 321 Ark. 143, 900 S.W.2d 191 (1995). III. Discussion A. Permit as a Function of Law First, Step maintains that a permit was granted—as a function of law—because the Commission failed to issue its order denying the permit within fifteen days as required by Arkansas Code Annotated section 20-8-103(g)(1) (Repl. 2023). Accordingly, Step argues that because the Commission did not reduce its decision to writing within the fifteen-day period, the Agency’s decision was ratified and became the final decision of the Commission. We disagree. 4 Arkansas Code Annotated section 20-8-103(g)(1) requires the Commission to conduct a hearing within ninety days of the agency decision. Thereafter, the Commission “shall render its final decision within fifteen (15) days of the close of the hearing.” Id. Failure to do so “shall be considered a ratification of the agency decision and shall constitute the final decision of the commission.” Id. Furthermore, Arkansas Code Annotated section 25- 15-210(b)(1) (Repl. 2024) provides that a “final decision” or order “shall be in writing or stated in the record.” This court reviews issues of statutory interpretation de novo. City of Ft. Smith v. Carter, 372 Ark. 93, 270 S.W.3d 822 (2008). Our supreme court has stated that the basic rule of statutory construction is to give effect to the intent of the General Assembly. Ryan & Co. AR, Inc. v. Weiss, 371 Ark. 43, 263 S.W.3d 489 (2007). In determining the meaning of a statute, our first rule is to construe it just as it reads, giving the words their ordinary and usually accepted meaning in common language. Id. This court construes the statute so that no word is left void, superfluous, or insignificant, and meaning and effect are given to every word in the statute if possible. Id. However, when the language of a statute is plain and unambiguous and conveys a clear and definite meaning, there is no need to resort to rules of statutory construction. Id. Here, the Commission rendered its decision at the administrative hearing on September 19, 2024. The decision to deny Step’s application was made on the record, and the hearing officer instructed the Commission to “reduce that decision to writing.” The Commission did so on October 14, 2024. We hold that the Commission adhered to the 5 plain and unambiguous language of Arkansas Code Annotated sections 20-8-103(g)(1) and 25-15-210(b) by rendering its final decision to deny Step’s application on the record at the administrative hearing. We agree with the Commission that if the legislature intended the statute to require that a final decision be reduced to writing within fifteen days, it would have said so. To hold otherwise would lead to an improper interpretation of clear statutory language. Accordingly, we reject Step’s argument that it was granted a permit as a function of law. B. Sufficiency of the Evidence Next, Step argues that the record demonstrated an unmet need for the services it sought to provide to the residents of Faulkner County. Specifically, Step maintains that the testimony and evidence presented by the licensed home-health-care providers focused only on the fact that APRN services are not required under the current home-health rules and failed to prove that home-health patients would not benefit from such services. Accordingly, Step asserts that the Commission’s decision to deny the application because it failed to meet the exception was not supported by substantial evidence. We disagree. The Administrative Procedure Act provides that a court may reverse or modify an agency’s order when the agency’s findings, inferences, conclusions, or decisions are (1) in violation of constitutional or statutory provisions; (2) in excess of the agency’s statutory authority; (3) made upon unlawful procedure; (4) affected by other error or law; (5) not supported by substantial evidence of record; or (6) arbitrary, capricious, or characterized by an abuse of discretion. Ark. Code Ann. § 25-15-212(h); see also Williform v. Ark. Dep’t of Hum. 6 Servs., 2018 Ark. App. 314, 551 S.W.3d 401. Here, Step has the burden of proving that there is an absence of substantial evidence. See Reynolds v. Ark. Appraiser Licensing & Certification Bd., 2019 Ark. App. 587, 591 S.W.3d 837. In order to do so, Step must demonstrate that “the proof before the administrative tribunal was so nearly undisputed that fair-minded persons could not reach its conclusions.” Id. at 7, 591 S.W.3d at 842. Here, Step contends on appeal that the testimony and evidence presented to the Commission showed that there is a great need for additional home-health service providers in Faulkner County and an unmet need for APRNs to provide “more robust evaluation and medical support for homebound people who lacked transportation to regularly see a doctor.” Moreover, Step argues that the Commission failed to properly interpret the law and regulations regarding “need.” First, as noted by the Agency—and by the hearing officer throughout the administrative hearing—Step’s application for the permit was not based on a need to serve Faulkner County. It is undisputed that the population-based methodology used by the Agency showed a “need” for home-health agencies of negative eight. Rather, Step applied for an exception to the population-based methodology, arguing that it could provide APRN services to the community and that no other home-health agencies were providing these services. An administrative agency’s interpretation of its own rules and regulations will not be overturned unless it is clearly wrong. Reynolds, 2019 Ark. App. 587, at 5, 591 S.W.3d at 841. It is well established that the administrative agency is better equipped than appellate courts to analyze legal issues dealing with its agency. Id. Therefore, to the extent that Step 7 is now arguing that the population-based methodology used by the agency to determine “need” is improper, we do not find that the Commission’s interpretation of its own regulations is clearly wrong. We next turn to whether the Commission’s decision to deny the permit on the basis of its finding that Step failed to qualify for the exception to the population-based methodology was supported by substantial evidence. Step advocates on appeal that because there was no testimony that having access to APRNs was not “desirable” or “useful” to home- health patients—only that it was not required—the record clearly established that Faulkner County could benefit from having access to APRNs and that the home-health needs of the citizens of Faulkner County are not being met. At the hearing, Ms. Green testified that Step provides nonskilled services such as bathing, grooming, oral-hygiene care, errands, and light housekeeping to fifteen families in Faulkner County. She stated her belief that approximately five of those families could benefit from home-health services. Ms. Green testified that someone with the credentials of an APRN could come into the home “and access and also give them the resources they need.” She also testified to disparities in home care, specifically for minorities, and explained that APRNs could provide care for homebound individuals. Ms. Green asserted that an APRN could better diagnose the severity of wounds. She did, however, concede that in the home- health context, an APRN is limited to providing the same level of care and treatment as a registered nurse (RN). 8 Steven Hammond, vice president of Care IV, testified that Care IV had been providing home-health services in Faulkner County for over thirty years. Mr. Hammond explained that Care IV does not provide APRN services because it is not in the scope of practice for home-health agencies, and the services are not covered under Medicare and Medicaid. He testified that Care IV has some APRNs that perform skilled visits; however, their services are no different than those provided by an RN. Similarly, Kelly Flowers, vice president of Elite Home Health, explained that APRNs must function under the scope of an RN in a home-health setting. Furthermore, Ms. Flowers testified that if a home-health patient needed APRN services, Elite Home Health would refer the patient to a service provider to provide those services, including those who travel to patients that have no form of transportation. Ms. Flowers stated that Elite Home Health, in fact, partners with several providers who provide in-home services, including UAMS Home Calls and Mid-South Transitions. Ms. Green acknowledged that she did not contact UAMS to determine whether it serves patients in Faulkner County. Moreover, there is no documentation or testimony in the record from any patient or Faulkner County resident that there is an unmet need for skilled home-health APRN services. Ms. Green acknowledged that she provided no letters or documentation from any of the fifteen families to whom she provides unskilled home-care services in Faulkner County stating a need for home-health services. There is also no documentation in the record from a Faulkner County resident or physician indicating an unmet need for APRN services in home-health care. At best, the Commission was presented with two conflicting views on 9 whether Step qualified for the exception, and our supreme court has held that “between two fairly conflicting views, even if the reviewing court might have made a different choice, the board’s choice must not be displaced.” Ark. Prof’l Bail Bondsman Licensing Bd. v. Oudin, 348 Ark. 48, 54, 69 S.W.3d 855, 860 (2002) (quoting Ark. Contractors Licensing Bd. v. Pegasus Renovation Co., 347 Ark. 320, 327, 64 S.W.3d 241, 245 (2001)). Having reviewed the Commission’s findings and evidence from the administrative hearing, we cannot say that Step has demonstrated that the Commission’s decision was not supported by substantial evidence. The standard to overturn an administrative agency’s decision is extremely high, and this court must defer to the specialized knowledge of the administrative agency. Reynolds, 2019 Ark. App. 587, at 12, 591 S.W.3d at 844. Accordingly, because there is evidence to support the Commission’s finding that Step did not qualify for the exception, i.e., there is not an unmet need in Faulkner County, we affirm the Commission’s decision to deny Step the permit. Affirmed. VIRDEN and TUCKER, JJ., agree. The Firm, PLLC: by: S.L. Smith, for appellant. Tim Griffin, Att’y Gen., by: Sarah DeBusk-Griffith, Ass’t Att’y Gen., for appellee. 10