Ten states require certification in place of licensure. Of these, Alaska, Colorado, Ohio, Indiana, and Wisconsin require only Medicaid providers to be certified according to ADS certification standards; non-Medicaid providers do not have be certified. Adult day certification is voluntary for non-Medicaid providers in Wisconsin. The District of Columbia requires Medicaid providers to be certified; non-Medicaid providers must follow Office on Aging contracting requirements.
Like states that license providers, states that require certification distinguish between different types of ADS programs. For example:
- Colorado certifies two types of centers: ADS and specialized.
- Ohio requires ADS programs to be certified as "enhanced" or "intensive" by the Ohio Department of Aging.
A few states certify Alzheimer's programs separately from other ADS programs. For example, Iowa certifies ADS programs as dementia-specific ADS programs. North Carolina does not have a separate certification, but allows certified adult day care centers to provide special care services by promoting programming, activities, or care specifically designed for persons with Alzheimer's disease or other dementias, mental health disabilities, or other special needs, diseases, or conditions. To provide special care services, providers must follow specific requirements in the certification standards.
Colorado is one state that does have specialized requirements for dementia-specific facilities. The state certifies specialized ADS centers (SADS) to provide intensive health supportive services for participants with a primary diagnosis of Alzheimer's or other dementias, Multiple Sclerosis, brain injury, chronic mental illness, or developmental disability or post-stroke participants who require extensive rehabilitative therapies. The state has staffing and service requirements specifically for SADS centers that differ from those for ADS centers.
One state has certification standards specific to co-location of an adult day care facility within an already licensed acute or LTC setting. Wisconsin's certification standards address adult day care programs operating in a multi-use facility that is not located in or connected to a nursing home (e.g., a residential care facility or hospital) and adult day care programs that are located in or connected to nursing homes. For the former, the standards addressed include staffing of the program from other parts of the multiuse facility to meet staff-to-participant ratios; planning of joint activities; space requirements (e.g., program must be separate from living areas); and facility requirements (e.g., program must have a separate door). For the latter, the standards list criteria related to external setting (e.g., name and location connote a community-based setting rather than a health care facility); interior setting (e.g., décor must reflect non-institutional settings); and integrity of the program that must be adopted (e.g., activities are unique and not part of nursing facility activity calendar).