Regulatory Review of Adult Day Services: Final Report - Section 2. Arizona

08/26/2005

Overview

The Department of Health Services licenses adult day health care facilities. The Arizona Administrative Code R9-10-501 to 514 serves as the basis for the licensing requirements. Tribal providers need approval from the tribal government or the Bureau of Indian Affairs to operate an adult day care/adult day health care facility. Medicaid providers of adult day health care must also be licensed and must meet a few additional Medicaid requirements.

Licensure and Certification Requirements

Licensure and Certification Requirements
Licensure Only  ☒
Certification Only  ☐
Both Required  ☐
Other  ☐

Definitions

Adult day health care facility means a facility providing adult day health services during a portion of a continuous 24-hour period for compensation on a regular basis for five or more adults not related to the proprietor.

Parameters for Who Can Be Served

Providers may not admit or retain participants whose behavior is dangerous to self or interferes with the physical or psychological well-being of other residents, or whose service requirements exceed those services for which the facility is licensed to provide.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☒
No  ☐

A licensee applying to renew a health care institution (an adult day care facility is defined as health care institution class or subclass) license shall submit an application packet to the Department at least 60 days but not more than 120 days before the expiration date of the current license. All initial licenses are issued for 1 year. The Department shall issue a renewal license for:

  1. 1 year, if a licensee is in substantial compliance with the applicable statutes and this Chapter, and the licensee agrees to implement a plan acceptable to the Department to eliminate any deficiencies; or
  2. 2 years, if a licensee has no deficiencies at the time of the Department's licensure inspection (if a facility has been issued a 2-year license, the department will conduct a renewal survey at the end of that licensing period).

Required and Optional Services

  Adult Day Health Care Facility Services
Required Optional
Activities of Daily Living (ADL) Assistance  ☒  ☐
Health Education and Counseling  ☐  ☐
Health Monitoring/Health-Related Services  ☒  ☐
Medication Administration  ☒  ☐
Nursing Services  ☒  ☐
Physical Therapy, Occupational Therapy, or Speech Therapy  ☐  ☐
Skilled Nursing Services  ☐  ☐
Social Services  ☒  ☐
Transportation  ☐  ☐

Provisions Regarding Medications

The administrator shall ensure that medications are ordered, administered, stored, and destroyed as follows:

  1. The participant's medical provider shall order, in writing, all medications and treatments. The orders shall include the name of the medication or treatment, method of administration, dosage, and frequency.
  2. A licensed nurse, medical provider, or an individual as provided by law shall administer medications that cannot be self-administered.
  3. A licensed nurse, family member, or an individual as provided by law may prepare patient medication organizers up to 1 month in advance for self-administration by participants.
  4. Staff may remind and supervise a participant who is functionally capable in the self-administration of medication according to the order of the medical provider and instruction of the pharmacist as indicated on the label of the individual container of medication. Supervision may include: (1) opening a bottle cap for a participant, (2) reading the medication label to the participant, (3) checking the self-administration dosage against the label of the container and reassuring the participant that the dosage is correct, and (4) observing the participant while the medication is taken.

Provisions for Groups with Special Needs

Provisions for Groups with Special Needs
Dementia  ☐
Mental Retardation/Developmental Disabilities  ☐
Other

 ☐

Staffing Requirements

Type of staff. An administrator shall have the authority and responsibility to operate the facility and manage adult day health services.

All personnel must be 18 years of age or older. An administrator must be 21 years of age.

A registered nurse shall supervise the health care needs of participants. A licensed nurse shall be on duty daily to perform the following functions: (1) administer medications and treatments, (2) monitor participant's health status, and (3) conduct initial health assessments. Each facility that is operated by a nursing care institution shall not share staff with the nursing care institution during the course of a day.

Staffing ratios. The administrator shall ensure that two staff members are on duty at all times when two or more participants are in the facility. One staff member, certified in cardiopulmonary resuscitation and trained in first aid, shall be on duty at all times.

Training Requirements

Within the first week of employment, all personnel must attend orientation that includes: (1) policies and procedures, including personnel procedures; (2) participant rights and facility rules; (3) protection of participant privacy and confidentiality; (4) basic infection control techniques, including hand washing and prevention of communicable diseases; and (5) fire, safety, and emergency procedures. All personnel must also attend 10 hours of in-service training per year, which may include time spent in orientation.

Personnel providing direct care to participants shall attend 4 or more hours of orientation, in addition to training listed above, before providing care to participants. The orientation shall include: (1) communication skills, (2) assistance with the activities of daily living, (3) personal living skills training, and (4) special needs of the elderly and functionally impaired.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

The state's entire Medicaid program--Arizona Long Term Care System (ALTCS)--operates under an 1115 waiver and covers services provided by licensed adult day health care facilities. If ALTCS members who reside in an adult foster care home, assisted living home, or assisted living center are to receive adult day health care services, special justification is required by the member's case manager and approval by the Contractor or Arizona Health Care Cost Containment System (AHCCCS) Administration. Members residing in a Level II or Level III behavioral health facility are not eligible to receive adult day health care services.

Admission. Services are available for members who are elderly and/or have physical disabilities who need supervision, assistance in taking medication, recreation and socialization, or personal living skills training.

Required services. Health monitoring and/or other health-related services such as preventive, therapeutic, and restorative health care services.

Location of Licensing, Certification, or Other Requirements

  1. http://www.azsos.gov/public_services/Title_09/9-10.pdf.
  2. http://www.ahcccs.state.az.us/Regulations/OSPpolicy/chap1200/Policy1240.asp.

Citations

  1. Department of Health Services--Health Care Institutions: Licensing-General and Adult Day Health Care Facilities (Title 9, Chapter 10, Articles 1 and 5 (R9-10-501 through 514)). Arizona Administrative Code. Article 5 adopted, effective April 4, 1994.
  2. Adult Day Health Care Services, Policy 1240--Home and Community Based Services, Chapter 1200--ALTCS Services/Settings for the Elderly and/or Disabled--AHCCCS Medical Policy Manual. Arizona Health Care Cost Containment System.
  3. Contracting requirements for Non-Medical Home and Community-Based Care Providers--Adult Day Care/Adult Day Health Care (Section 7.3). Aging and Adult Administration, Department of Economic Security. [Hard copy only]

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