States that neither license nor certify generally require publicly funded ADS providers to enter into official, most often contractual, agreements with a state agency, specifying that they will comply with mandated requirements. These states do not have any requirements for providers who serve only private-pay clients. For example:
- Alabama requires adult day care providers receiving Department of Human Resources funds to enter into contracts with the Office of Social Service Contracts. Elderly and Disabled Waiver providers must have specific approval to offer adult day health care from the state Medicaid agency. The agency outlines specific requirements in its provider manual.
- Illinois requires ADS providers that have contracts under the Community Care Program (CCP) and are funded by state general revenues and the Medicaid waiver to follow CCP program regulations outlined in the administrative code.
- Mississippi requires publicly funded adult day care providers to enter into an agreement that uses a set of quality assurance standards. (The Mississippi legislature is considering certification or licensure requirements.)
- South Dakota requires publicly funded adult day care providers, including Medicaid Aged and Disabled Waiver providers who have a contractual relationship with the Office of Adult Services and Aging, to abide by adult day care regulations.
- Washington requires adult day care or day health centers that contract with the Department of Social and Health Services, an area agency on aging, or other Department designees to provide Medicaid services to department clients to abide by specific contracting requirements.
Two states have operating standards for providers:
- Michigan's Office of Services to the Aging (OSA) provides operating standards for service programs to be followed by publicly funded providers of adult day care services. Services may be provided only under an approved area plan through a formal contractual agreement between the area Agency on Aging and service provider agency. Medicaid (PACE [Program for All-Inclusive Care for the Elderly] and waiver) adult day health care providers are also required to follow the OSA standards.
- Oregon has voluntary operating standards for ADS providers. However, all ADS providers (except for licensed LTC facilities providing ADS programs) are required to register their programs on a registry administered by the Department of Human Services, Seniors, and People with Disabilities and state their intent to voluntarily comply with the standards.
One state specifically developed provider standards to follow the Commission on Accreditation of Rehabilitation Facilities adult day services standards. The Idaho Commission on Aging requires adult day care programs to operate under guidelines it established, which are in accordance with the standards developed by the Commission on Accreditation of Rehabilitation Facilities.
One state has a separate type of arrangement/agreement specific to co-location of an adult day care facility within another acute or LTC setting. Adult day care services providers who want to operate in a licensed basic care or skilled nursing facility must obtain approval from the North Dakota Department of Health. There are no other requirements for adult day care providers operating in stand-alone or other types of facilities. Medicaid Aged and Disabled waiver adult day care providers must follow a separate set of administrative rules.
One state has an agreement that separately addresses services to persons with special needs. Michigan's operating standards recognize two types of adult day community services: adult day care and dementia adult day care. Some standards are the same for both types and some differ.