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

08/26/2005

Overview

All facilities offering adult day or adult day health care (ADHC) must be licensed by the Bureau of Licensure and Certification in the Department of Human Resources Division.

Nevada provides adult day care and adult day health care under the Community Home Based Initiatives Program (CHIP) and Medicaid State Plan (hereafter referred to as State Plan) and provides adult day care under the Frail Elderly Waiver. Frail Elderly Waiver providers have additional requirements outlined in their waiver manual. All Medicaid providers must be licensed, and State Plan providers must also meet adult day health care certification standards.

The Department of Human Resources Division for Aging Services also provides adult day care in licensed facilities through grants to licensed providers who also comply with additional service specifications described below for the Grant program. The profile contains licensing requirements, grant specifications, and State Plan certification standards.

Licensure and Certification Requirements

Licensure and Certification Requirements
Licensure Only  ☐ 
Certification Only  ☐ 
Both Required  ☒  adult day care and adult day health care licensed; Medicaid State Plan providers certified
Other  ☐ 

Definitions

Licensing

Facilities for the care of adults during the day means an establishment operated and maintained to provide care during the day on a temporary or permanent basis for aged or infirm persons. The term does not include a halfway house for recovering alcohol and drug abusers.

Grant Specifications

Adult day care/adult day health. Provision of personal care for dependent adults in a supervised, protective, congregate setting during some portion of a 24-hour day.

Adult day care/social model. Provision of personal care for adults in a supervised, protective, congregate setting during some portion of a 24-hour day.

State Plan

Adult day care facility is defined as an establishment operated and maintained to provide temporary or permanent care during the day for aged or infirm persons but does not include halfway houses for recovering alcoholics or drug abusers.

Adult day health care facilities provide medical services and oversight in addition to social, health, and nutrition services. ADHC consists of structured, comprehensive, and continually supervised components that are provided in a protective setting. Recipients receive services and attend on a planned basis during specified hours.

Adult day health care. The goals of adult day health care services are to: (1) safeguard the recipient's safety and well being and maintain and/or enhance his/her quality of life and (2) improve and maintain the recipient's level of functioning or to lessen any decline in functioning due to disease and/or the aging process.

Parameters for Who Can Be Served

Licensing requirements. None identified.

Grant specifications. Providers may not serve participants who are bedridden, unmanageable, contagious, or lacking in the stamina to attend the program for 5 hours per day. Persons who are human immunodeficiency virus (HIV) positive or have acquired immune deficiency syndrome (AIDS) are not considered contagious.

State plan. Providers may serve individuals age 18 or older who meet the criteria for placement in a nursing facility and are in need of the medical and social services provided by adult day health care.

Medicaid-eligible individuals whose primary diagnosis includes alcohol or drug abuse or mental health disorders will not be commingled in an adult day health care facility with individuals whose primary diagnosis is an age-related disorder (dementia, physical illness, physical infirmity).

Inspection and Monitoring

Inspection and Monitoring
Yes  ☒ 
No  ☐ 

Licensing requirements. None identified.

Grant specifications. None identified.

State plan. Medicaid conducts an initial review, and may schedule an on-site review at any given time without cause to assure the facility maintains compliance with the Medicaid criteria.

Required and Optional Services

  CHIP Adult Day Care/Adult Day Health State Plan Adult Day Health Care
Required Optional Required Optional
* As required by the Licensing Regulations.
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

Licensing requirements. Procedures must be established for the administration of medication to clients, either directly by the client or by an employee.

Grant specifications. Adult day care/adult day health participants typically receive medication assistance. Participants of social adult day care programs must be able to administer their own medications. If the facility accepts a participant who is not able to administer his/her medication, a licensed practical nurse (LPN) may be allowed to provide this service under the supervision of a contracted registered nurse (RN).

State plan. Medication assistance will be provided for participants receiving adult day health services. An RN, or LPN under the supervision of an RN, will administer medications provided to the recipient while in the facility's care.

Provisions for Groups with Special Needs

Provisions for Groups with Special Needs
Dementia  ☒  (SP)
Mental Retardation/Developmental Disabilities  ☐ 
Other  ☒  HIV/AIDS (Grant)

Staffing Requirements

Licensing Requirements

Type of staff. Each facility must have the number and kind of employees required by the physical characteristics of the facility, the number of clients, and the services provided. The facility director must designate an acting director to act when the director is absent from the facility.

Staffing ratios. A client must be supervised by an employee of the facility at all times during the operational hours of the facility. At least one employee trained to administer first aid and cardiopulmonary resuscitation (CPR) must be on the premises at all times.

Grant Specifications

Type of staff. None identified.

Staffing ratios. A client must be supervised by an employee of the facility at all times during the operational hours of the facility.

State Plan

Type of staff. The facility must employ an RN to oversee and provide medical services ordered by a physician. An RN, or LPN under the supervision of an RN, must be on duty during the hours in which a Medicaid-eligible recipient is in attendance at the facility.

The facility must employ a program director. The facility must have direct care staff, who observe the recipient's functioning and provide assistance to the recipient in the skills of daily living.

The facility must also provide for activity staff or other staff as necessary to provide the required services and ensure each recipient's needs are met.

Staffing ratios. None identified.

Training Requirements

Licensing requirements. All employees and volunteers shall participate in a program of general orientation to inform them of the programs, policies, and services of the facility, and must receive training at the facility on a regular basis, but not less than 12 hours per year.

Grant specifications. Staff and volunteers must be provided training in working with disabled adults.

State plan. Staff must have the necessary training to provide the Medicaid required services.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

Nevada provides adult day care and adult day health care under the CHIP waiver service, and the State Plan as outlined in this profile.

Nevada also provides social model adult day care under the Frail Elderly Waiver with the following adult day care specific provider provisions from Section 2200 of the Medicaid Services Manual:

Social model adult day care means day care service provided for 4 or more hours per day on a regularly scheduled basis, for 1 or more days per week, in an outpatient setting. Day care centers provide care and supervision, the monitoring of general health, social interaction and peer contact for the physically or mentally impaired or socially isolated adult so that he or she can remain in the community.

Providers are required to meet and maintain the specifications as a social day care center provider outlined in Nevada Revised Statutes 449, which are outlined under the Licensing Requirements headings in this profile.

Location of Licensing, Certification, or Other Requirements

  1. http://www.dhcfp.state.nv.us/msm/ch%201800%208-26-03.pdf
  2. http://www.nvaging.net/grants/serv_specs/adc.htm or http://www.nvaging.net/grants/serv_specs/Adult%20Daycare%202-05.pdf
  3. http://www.leg.state.nv.us/NAC/NAC-449.html#NAC449Sec4061
  4. http://www.leg.state.nv.us/NRS/NRS-449.html#NRS449Sec240
  5. http://www.dhcfp.state.nv.us/MSM/Ch%202200%208-26-03.pdf

Citations

  1. Medicaid Services Manual, Adult day Health Care. Division of Health Care Financing and Policy. [8/26/2003]
  2. Service Specifications Adult Day Care. State of Nevada Division for Aging Services. [2/2005]
  3. Facilities for Care of Adults During the Day. Nevada Administrative Code Chapter 449. Medical and Other Related Facilities.
  4. Licensing, Regulation, and Inspection. Nevada Revised Statutes Chapter 449. Medical and Other Related Facilities.
  5. Medicaid Services Manual, Home and Community Based Waiver for the Frail Elderly. Division of Health Care Financing and Policy. [8/26/03]

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