Regulatory Review of Adult Day Services: Final Report - Section 1. Relevant Medicaid Contracting Requirements

Relevant Medicaid Contracting Requirements All states fund ADS for elderly persons through either their Medicaid State Plan or waiver program. State primarily use 1915(c) waivers; Tennessee is an exception using an 1115 waiver. Providers of Medicaid-funded ADS must meet all applicable regulatory requirements whether they include licensure, certification, or some other arrangement. Over one-third of the states require ADS providers to meet additional Medicaid provisions. Exhibit 4 indicates the states that have additional Medicaid requirements.

Additional Medicaid requirements are generally for ADS providers who furnish adult day health care services to waiver participants. Many of the states with additional Medicaid requirements license or certify adult day care only, while the Medicaid requirements are for adult day health care. These requirements, often health services, are in addition to those required for licensure and include additional staffing (type and number) and training. Some examples follow:

• Maine defines adult day health services and more extensively addresses services, staffing, and monitoring by waiver providers. Adult day health services provided under the Medicaid State Plan have the same or similar requirements as the waiver program.
• Mississippi's additional requirements for Aged and Disabled Waiver providers include more detailed parameters for who can and cannot be served by, for example, describing individuals who are inappropriate for adult day service programs.
• Missouri licenses adult day care but has additional requirements for Aged and Disabled Waiver providers of adult day health care, including more extensive staffing (type and ratios) requirements.
• Oklahoma licenses adult day care but has additional requirements for ADvantage Waiver Program providers, including the provision of services not mandatory for adult day care providers, such as physical, occupational, speech/language, and/or respiratory therapy.
• South Carolina licenses adult day care services but has additional requirements for Community Long-Term Care Medicaid Waiver providers related to nursing staff-to-participant ratios and care managers.

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