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

08/26/2005

Overview

Adult day care (ADC) in Idaho is regulated for persons served by the Commission on Aging Senior Services Program under the Rules Governing Senior Services Programs. The Commission on Aging rules state that adult day care programs shall operate under guidelines established by the Idaho Commission on Aging that are in accordance with the standards developed by the National Council on Aging, National Institute on Adult Day Care (now known as the standards of the Commission on Accreditation of Rehabilitation Facilities).

Adult day care services are provided under the Medicaid Aged and Disabled Waiver, and waiver providers are governed by the Department of Health and Welfare Division of Medicaid, the Home and Community-Based Services (HCBS) Medicaid Guide, Provider Handbook, and additional terms for ADC to the Medicaid Provider Agreement.

Licensure and Certification Requirements

Licensure and Certification Requirements
Licensure Only  ☐ 
Certification Only  ☐ 
Both Required  ☐ 
Other  ☒  ADC providers must follow guidelines in accordance with CARF standards; Medicaid ADC providers must follow specific terms in Provider Agreement

Definitions

Adult day care is a structured day program that provides individually planned care, supervision, social interaction, and supportive services for frail older persons in a protective group setting, and provides relief and support for caregivers. It is designed to meet the needs of eligible participants whose functional or cognitive abilities have deteriorated; it is intended to provide relief for family caregivers; and it is a comprehensive program that provides a variety of social and other elective support services in a protective setting other than the participant's home during any part of a day, but for less than 14 hours per day.

Parameters for Who Can Be Served

Providers may serve individuals who have physical or cognitive disabilities affecting ADL or instrumental ADL; are capable of being transported and of benefiting from socialization, structured, and supervised group-oriented programs; and are capable of self-care with supervision or cueing.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☒ 
No  ☐ 

Required and Optional Services

  Adult Day Care
Required Optional
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

None identified.

Provisions for Groups with Special Needs

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

Staffing Requirements

Type of staff. Staff shall be adequate in numbers and skill to provide essential services.

If the site administrator is responsible for more than one site or has duties not directly related to ADC, a program manager shall be designated for each site. If the ADC occurs in other than a freestanding facility, such as in a nursing facility or assisted living facility, the rules governing that facility must also be followed. Adult day care does not, however, have a rule governing the site administrator for a stand-alone facility.

Staffing ratios. There shall be at least two responsible persons at the center at all times when clients are in attendance. One shall be a paid staff member. Staff-to-client ratio shall be increased appropriately if the number of clients in day care increases or if the degree of severity of clients' functional or cognitive impairment increases. Staff persons counted in the staff-to-client ratio shall be those who spend the major part of their work time in direct service to clients. Volunteers may be included in the staff ratio only when they conform to the same standards and requirements as paid staff.

Training Requirements

None identified.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

Idaho provides ADC under the Aged and Disabled Waiver.

Definitions

Adult day care is a supervised, structured day program outside of the home of the client that may offer one or more of a variety of social, recreational, or health activities; supervision for safety; and assistance with ADL. Adult day care can be provided in a home or elsewhere in the community.

Admission criteria. Centers may accept clients who are receiving service through one of the participating HCBS waivers, and who do not have pressure ulcers or open wounds, draining wounds that cannot be contained, or who require continuous nursing assessment and intervention. Providers shall accept participants only if they are able to provide the level or type of service the participant requires, including skilled nursing and sufficient staffing, and whose needs are compatible with the physical, emotional, and social needs of the other participants at the facility and within the level of fire safety provided by the facility.

Required services. Medication administration and nursing.

Medications. Medications may be administered only by licensed nurses. Any staff member who assists with medications must be licensed to do so or must successfully complete a Board of Nursing-approved course on assistance with medication, as the delegate of a licensed nurse.

Inspections. Idaho Medicaid conducts a review every 2 years of all provider agencies. Regional Medicaid Services contacts agencies at least 30 days prior to a review.

Staffing ratios. The provider shall employ sufficient personnel to ensure the safe and proper care of the participants. The staff-to-participant ratio shall be a minimum of one staff to six participants. As the number of participants and the severity of participant functional impairments increases, the staff-to-participant ratio shall be adjusted accordingly. Programs serving a high percentage of participants who are severely impaired should have a staff-to-participant ratio of one-to-four.

Training. The provider shall ensure that the staff has sufficient training. At a minimum, providers shall have training in infection control, cardiopulmonary resuscitation (CPR), and first aid.

Location of Licensing, Certification, or Other Requirements

  1. http://www2.state.id.us/adm/adminrules/rules/idapa15/0101.pdf
  2. http://www.healthandwelfare.idaho.gov/_Rainbow/Documents/medical/s3_015_aged_disabled.pdf
  3. http://www.healthandwelfare.idaho.gov/_Rainbow/Documents/medical/Master%20Idaho%20HCBS% 20Medicaid%20Provider%20Orientation%20Guide%20Part%20I%207-04.pdf
  4. http://www.healthandwelfare.idaho.gov/_Rainbow/Documents/medical/Master%20Idaho%20HCBS% 20Medicaid%20Provider%20Orientation%20Guide%20Part%20II%207-04.pdf
  5. On file at RTI International, provided by Idaho Medicaid.

Citations

  1. Rules Governing Senior Services Program (IDAPA 15, Title 01, Chapter 01)--Office of the Governor, Idaho Commission on Aging. [2004]
  2. Medicaid Provider Handbook, Aged and Disabled Waiver Guidelines. Idaho Department of Health and Welfare. [6/1/04]
  3. Idaho HCBS Medicaid Guide. General Information Part I. Idaho Department of Health and Welfare. Division of Medicaid. [July 2004]
  4. Idaho HCBS Medicaid Guide. Medicaid Programs Part II. Idaho Department of Health and Welfare. Division of Medicaid. [July 2004]
  5. Additional Terms--Adult Day Care. Idaho Medicaid Provider Enrollment Packet Adult Day Care Services Medicaid Provider Agreement. [5/10/04]

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