ADULT DAY HEALTH (ADH) SERVICES PROVIDER IN MASSACHUSETTS

Fatumata Kaba
Aug 7, 2025
4 min read

PROVIDING CLINICALLY-SUPERVISED DAYTIME CARE FOR ADULTS WITH MEDICAL OR FUNCTIONAL NEEDS TO SUPPORT HEALTH, WELLNESS, AND COMMUNITY LIVING

Adult Day Health (ADH) services in Massachusetts provide nursing oversight, personal care, case management, therapeutic activities, and meals in a structured community setting. These services are regulated by the Massachusetts Department of Public Health (DPH) and reimbursed by MassHealth (Medicaid) for eligible adults through a medical model of day care.

1. GOVERNING AGENCIES

Agency: Massachusetts Department of Public Health (DPH)

Role: Licenses and inspects Adult Day Health programs per 105 CMR 158.000

Agency: MassHealth (Massachusetts Medicaid)

Role: Reimburses ADH services and defines clinical eligibility and operational standards

Agency: Executive Office of Health and Human Services (EOHHS)

Role: Establishes programmatic and rate-setting guidance for ADH providers

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Ensures compliance with Medicaid and HCBS waiver regulations

2. ADULT DAY HEALTH SERVICE OVERVIEW

Adult Day Health programs provide structured services for adults with chronic illness, physical/cognitive impairments, or behavioral health needs, and who are at risk of institutionalization.

Core services include:

Skilled nursing services (e.g., vitals, medication administration, wound care)
Assistance with ADLs (e.g., bathing, dressing, toileting)
Case management and care coordination
Meals and dietary support
Therapeutic and recreational activities
Transportation (optional/additional service)

ADH centers typically operate 5–6 hours per day, Monday through Friday, and participants attend regularly based on need and authorization.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

To operate an ADH program in Massachusetts, you must:

Obtain licensure through the DPH Bureau of Health Care Safety and Quality under 105 CMR 158
Meet facility requirements for square footage, accessibility, and infection control
Employ licensed staff including an RN, activity director, case manager, and aides
Maintain participant records, care plans, and clinical documentation
Enroll with MassHealth for reimbursement

4. DPH LICENSURE PROCESS

Step 1: Business Formation

Register entity via https://www.mass.gov/orgs/secretary-of-the-commonwealth
Obtain EIN and NPI

Step 2: Site Acquisition and Buildout

Identify location that meets fire safety, ADA, and health codes
Design rooms for clinical services, activities, dining, and rest areas

Step 3: DPH Application and Policies Submission

Submit licensure application with required attachments:
- Staffing plan, org chart, policies/procedures, sample forms
- Lease/deed, floor plans, food service documentation
- Infection control plan and emergency preparedness plan

Step 4: DPH Survey and Approval

Pass on-site inspection
Receive licensure to operate as an Adult Day Health center

5. MASSHEALTH ENROLLMENT & SERVICE AUTHORIZATION

Step 1: Enroll as a MassHealth Adult Day Health Provider

Step 2: Submit provider contract and rate documentation

Step 3: Accept referrals through MassHealth LTSS programs, SCO (Senior Care Options), or ACOs

Step 4: Provide services per care plans and submit billing through the LTSS Provider Portal

6. REQUIRED DOCUMENTATION

Articles of Organization or LLC registration
IRS EIN and Type 2 NPI
DPH ADH license
MassHealth provider contract
Comprehensive policy and procedure manual including:
- Nursing protocols and MAR logs
- Service and care plan templates
- ADL documentation and attendance logs
- Participant intake and consent forms
- Emergency and disaster plans
- Infection control and cleaning logs
- Staffing supervision records
- Client rights, privacy, and grievance procedures

7. STAFFING REQUIREMENTS (PER DPH 105 CMR 158)

Required Roles:

Registered Nurse (RN): Full-time during operating hours; oversees clinical services
Case Manager (e.g., LSW): Coordinates participant services and PCP communication
Activity Director: Plans and delivers therapeutic programs
Personal Care Staff (CNA/HHA): Assists with ADLs
Program Director (Admin): Ensures operational compliance and supervision

Recommended:

On-call medical director (physician)
Social worker, dietitian, behavioral health consultant

Training Requirements:

CPR, first aid, and medication administration
Infection control and universal precautions
Person-centered planning and cultural competence
Abuse, neglect, and elder protection reporting
HIPAA and documentation standards

8. MASSHEALTH ELIGIBILITY & REIMBURSEMENT

Participants must:

Be MassHealth-eligible (Standard or CommonHealth)
Have medical necessity for nursing supervision or ADL assistance
Be at risk for institutionalization without ADH support

MassHealth reimburses per level of care:

Basic Level – For participants needing basic nursing and ADL support
Complex Level – For those requiring more intensive clinical interventions
Transitional Level – For participants being discharged from a facility

Rates are set by EOHHS and billed through MassHealth LTSS or contracted MCOs.

9. TIMELINE TO LAUNCH

Phase: Business and Facility Setup

Timeline: 2–4 weeks

Phase: Policy Manual and Staffing Plan

Timeline: 3–5 weeks

Phase: DPH Application and Site Readiness

Timeline: 8–12 weeks

Phase: MassHealth Enrollment and Referral Activation

Timeline: 4–6 weeks (can overlap)

10. CONTACT INFORMATION

Massachusetts Department of Public Health (DPH)

Website: https://www.mass.gov/orgs/department-of-public-health

Licensing Unit: https://www.mass.gov/guides/apply-for-a-health-care-facility-license

MassHealth Provider Enrollment

Website: https://massfinance.ehs.state.ma.us

MassHealth Adult Day Health Program

Program Manual: https://www.mass.gov/doc/adult-day-health-provider-manual

LTSS Provider Portal

Billing and documentation: https://ltss.mass.gov

WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — MASSACHUSETTS ADULT DAY HEALTH PROVIDER

We help healthcare entrepreneurs and community leaders launch compliant and impactful Adult Day Health centers that meet the needs of Massachusetts residents with complex medical or support needs.

Scope of Work: