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

08/26/2005

Overview

The Washington Administrative Code 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 designee to provide Medicaid services to department clients, to abide by specific contracting requirements.

An area agency on aging that elects to provide adult day services using Senior Citizens Services Act funding or respite care funding must contract with an adult day center that meets all administrative and facility requirements under WAC 388-71-0736 through 388-71-0774. The adult day care or day health services funded through the Senior Citizens Services Act or respite care funding must be the same as the required Medicaid day care services or the day health services required under WAC 38871-0704 and 388-71-0706. The Medicaid contracting requirements are documented in this profile. We were not able to identify any requirements for providers who do not receive public funding.

Licensure and Certification Requirements

Licensure and Certification Requirements
Licensure Only  ☐ 
Certification Only  ☐ 
Both Required  ☐ 
Other  ☒  Medicaid contracting requirements

Definitions

Adult day services is a generic term referring to adult day care and adult day health services.

Adult day center means an adult day care or adult day health center. A day care or day health center for purposes of these rules is a center operating in a specific location, whether or not the center's owner also operates adult day centers in other locations.

Adult day care is a supervised daytime program providing core services appropriate for adults with medical or disabling conditions that do not require the intervention or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of the client's physician.

Adult day health is a supervised daytime program providing skilled nursing and rehabilitative therapy services in addition to core services provided in adult day care. Adult day health services are only appropriate for adults with medical or disabling conditions that require the intervention or services of a registered nurse (RN) or licensed rehabilitative therapist acting under the supervision of the client's physician.

Parameters for Who Can Be Served

The Medicaid Program has different eligibility criteria for adult day care an adult day health care. These criteria indicate the parameters for who can be served in these settings.

Adult day care. Participants who need the following services may be served: (1) personal care services, (2) routine health monitoring with consultation from an RN, (3) general therapeutic activities, and (4) supervision and/or protection when necessary for clients' safety.

Individuals cannot be served if their needs exceed the scope of authorized services that the adult day care center is able to provide or if they are not capable of participating safely in a group care setting.

Adult day health care. Participants 18 years of age or older who need the following services may be served: (1) skilled nursing or skilled rehabilitative therapy or (2) personal care.

Individuals cannot be served if their needs exceed the scope of authorized services that the adult day health center is able to provide or if they are not capable of participating safely in a group care setting.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☒ 
No  ☐ 

The department, or an area agency on aging, or other department designee, must determine that the adult day care or adult day health center meets the applicable adult day care or day health requirements and any additional requirements for contracting through a COPES or Medicaid provider contract. The area agency on aging or other department designee monitors the adult day center at least annually to determine continued compliance with adult day care and day health requirements and the requirements for contracting.

Required and Optional Services

  Adult Day Care Adult Day Health Care
Required Optional Required Optional
Additional required or optional services in adult day care and adult day health care, which are not identified in the exhibit above, include meals and snacks (required), general therapeutic activities (e.g., relaxation therapy and cognitive stimulation) (required), and assistance with arranging transportation (required). Psychological or counseling services are required in adult day health.
Activities of Daily Living (ADL) Assistance  ☒   ☐   ☒   ☐ 
Health Education and Counseling  ☒   ☐   ☒   ☐ 
Health Monitoring/Health-Related Services  ☒   ☐   ☒   ☐ 
Medication Administration  ☐   ☒   ☒   ☐ 
Nursing Services  ☒ (consultation)   ☐   ☒   ☐ 
Physical Therapy, Occupational Therapy, or Speech Therapy  ☐   ☐   ☒   ☐ 
Skilled Nursing Services  ☐   ☐   ☒   ☐ 
Social Services  ☒ (consultation)   ☐   ☒   ☐ 
Transportation  ☐   ☐   ☐   ☐ 

Provisions Regarding Medications

The center must develop written policies that are explained and accessible to all staff, contractors, volunteers, and participants The requirements for those policies and medication administration are found in WAC 388-71-0764. Participants who need to take medications while at the center, and who are able to self medicate, must be encouraged and expected to bring and take their own medications as prescribed. Some participants may need assistance with their medications, and a few may need to have their medications administered by qualified program staff. In order for center staff to administer any prescribed medication, there must be a written authorization from the participant's authorizing practitioner stating that the medication is to be administered at the program site.

Provisions for Groups with Special Needs

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

Staffing Requirements

Type of staff. Minimum staffing requirements for adult day care centers include an administrator/program director, activity coordinator, a consulting registered nurse, and a consulting social worker. Minimum staffing requirements for adult day health centers include an administrator,program director, RN, activity coordinator, a physical therapist/occupational therapist or speech therapist, and a social worker. The administrator and program director may be the same person.

If the center hires staff commonly used by both adult day care and adult day health centers (e.g., nurse, activity coordinator, social services professional, and personal care aides), the staff must meet specific requirements. The nurse must be an RN with valid state credentials and have at least 1 year of applicable experience (full-time equivalent). In addition to an RN, an adult day center can utilize a licensed practical nurse (LPN), but the LPN must be supervised in compliance with all applicable nurse practice acts and standards. The LPN must have valid state credentials and at least 1 year of applicable experience (full-time equivalent).

Staffing ratios. The ratio must be a minimum of one staff to six participants. Staff counted in the staff-to-participant ratio are those who provide direct service to participants. When there is more than one participant present, there must be at least two staff members on the premises, one of whom is directly supervising the participants.

Training Requirements

Provision must be made for orientation of new employees, contractors, and volunteers. All staff, contractors, and volunteers must receive, at a minimum, quarterly in-service training and staff development that meets their individual training needs to support program services. Staff, contractors, and volunteers must receive training about documentation, reporting requirements, and universal precautions. At a minimum, one staff person per shift must be trained and certified in cardiopulmonary resuscitation (CPR). Staff and volunteers must receive training on all applicable policies and procedures.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

Medicaid providers must follow the rules for adult day services found in the Washington Administrative Code that regulate the provision of all adult day care and adult day health care services in the state.

Location of Licensing, Certification, or Other Requirements

  1. http://www.leg.wa.gov/wac/index.cfm?fuseaction=chapterdigest&chapter=388-71

Citations

  1. Washington Administrative Code--Department of Social and Health Services--Home and Community Services and Programs--Adult Day Services--(Title 388 Chapter 71-0702 through 71-0776).

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