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. Med
Overview There are no licensure requirements in the State of Alaska for adult day services. There is no oversight for adult day service programs that serve only private pay clients.
Overview Alabama provides adult day care (ADC) as a function of Adult Protective Services, under the Department of Human Resources, under Adult Day Care Requirements from the Office of Social Service Contracts.
Regulatory Review of Adult Day Services: Final Report SECTION 2. STATE REGULATORY PROFILES
We did not identify this requirement in the rules; a state staff person who reviewed the profile provided this information.
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, certifi
The majority of states require inspections--most of them annual inspections that coincide with an initial license application and annual license renewal. Several states also stipulate that unannounced visits by state personnel can occur at any time. Only one state does not have external monitoring. Alaska does not license or monitor ADS. The state
Virtually all states have both orientation and initial and ongoing training requirements, but they are minimal. Some requirements are quite general, while others are specific regarding the type of training and the number of hours required. Most states require at least one staff trained in first aid and CPR on duty at all times. Examples of the wid
States vary with regard to the number of staff required. Most states specify minimum staff-to-participant ratios. As shown in Exhibit 2 , mandatory ratios range between one to four and one to ten. Some states require different ratios for different types of ADS, and some states specify both a required ratio and a recommended ratio. Some states re
Most states do not specify medication administration as a required service, except for adult day health care providers. The majority of states require licensed personnel to administer medications. States that permit unlicensed staff to administer medications generally required that they do so under nurse delegation provisions, though a few require
All states identify a range of required and optional ADS in their licensing or certification requirements or other types of agreements. States list required and optional services for each type of ADS that they license, certify, or otherwise regulate (e.g., for adult day care and adult day health care). The services we included in our review are:
The regulation of a service targeted to frail elders and individuals with disabilities needs to assure that providers can meet the needs of their clients. One option for assuring this is through explicit admission/retention/discharge criteria that set the parameters for who can be served.
Regulatory Review of Adult Day Services: Final Report - Section 1. Definitions of Adult Day Services
States vary considerably in the terms they use for ADS. For example, Arizona and Pennsylvania license adult day health care facilities , Delaware and New Mexico license adult day care facilities , and Oklahoma licenses adult day care centers . West Virginia licenses medical adult day care centers as a special type of ambulatory h
Regulatory Review of Adult Day Services: Final Report - Section 1. Other Required Types of Provider Agreements
States that neither license nor certify generally require publicly funded ADS providers to enter into official, most often contractual, agreements with a state agency, specifying that they will comply with mandated requirements. These states do not have any requirements for providers who serve only private-pay clients. For example:
Only four states both license and certify providers. Kentucky licenses Medicaid providers of adult day health care but certifies facilities for the Adult Day Care and Alzheimer's Respite program. Nevada requires all facilities offering adult day or adult day health care to be licensed (including Medicaid waiver and State Plan providers) and requir
Ten states require certification in place of licensure. Of these, Alaska, Colorado, Ohio, Indiana, and Wisconsin require only Medicaid providers to be certified according to ADS certification standards; non-Medicaid providers do not have be certified. Adult day certification is voluntary for non-Medicaid providers in Wisconsin. The District of Col
States vary in their approach to licensure, primarily licensing providers of specific ADS programs or operators of specific types of facilities or centers. Some states license a single program; others cover two or more program types under a single licensing category; some have separate licenses for specific types of programs in addition to basic l
Regulatory Review of Adult Day Services: Final Report - Section 1. Licensing, Certification, and Other Requirements
The majority of states approach ADS regulation by requiring licensure or certification in accordance with state standards. 25 states require licensure, ten states require certification; and four states require both licensure and certification (in these states, Medicaid and non-Medicaid providers have different requirements.) Thirteen states requir
Regulatory Review of Adult Day Services: Final Report SECTION 1. OVERVIEW OF ADULT DAY SERVICES REGULATIONS This section provides a brief overview of states' approaches to regulating ADS providers in key areas and highlights similarities and differences among them.