ADULT DAY HEALTH CARE (ADHC) SERVICES PROVIDER IN CALIFORNIA

Fatumata Kaba
Jul 6
4 min read

ENHANCING HEALTH, INDEPENDENCE, AND SOCIAL CONNECTIONS FOR ADULTS WITH MEDICAL AND COGNITIVE NEEDS IN A COMMUNITY SETTING

Adult Day Health Care (ADHC) Services in California offer coordinated health, therapeutic, and social services to individuals with chronic conditions, developmental disabilities, or cognitive impairments. ADHC is a licensed, community-based medical model authorized under California Medi-Cal through the Community-Based Adult Services (CBAS) Program and also coordinated by Managed Care Plans.

1. GOVERNING AGENCIES

Agency: California Department of Aging (CDA)

Role: Licenses ADHC centers and oversees CBAS program standards and audits

Agency: California Department of Health Care Services (DHCS)

Role: Manages Medi-Cal enrollment, provider reimbursement, and eligibility for CBAS participants

Agency: Managed Care Plans (e.g., LA Care, Health Net, Anthem)

Role: Authorize and coordinate CBAS services for enrolled members

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight and ensures HCBS compliance under Medicaid and Medicare

2. ADULT DAY HEALTH CARE SERVICE OVERVIEW

ADHC centers provide a structured day program that combines healthcare, therapeutic services, and social engagement in a non-residential setting. The goal is to help adults remain safely in the community, delay institutionalization, and support caregivers.

Approved providers may deliver:

Skilled nursing care and medication management
Physical, occupational, and speech therapy
Social services and case management
Mental health counseling
Daily personal care and hygiene assistance
Therapeutic and recreational activities
Nutritional meals and dietary counseling
Transportation to and from the center (if authorized)

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the California Secretary of State
Obtain EIN from the IRS and NPI (Type 2)
Secure a physical location that meets CDPH health facility standards
Apply for an ADHC license from the California Department of Public Health (CDPH)
Complete enrollment in the CBAS program with the California Department of Aging (CDA)
Obtain Medi-Cal provider enrollment approval and contracts with Managed Care Plans
Hire multidisciplinary staff including RNs, therapists, social workers, and aides
Maintain liability, malpractice, and facility insurance

4. PROVIDER ENROLLMENT PROCESS

Step 1: CDPH Licensing

Apply for ADHC license as a healthcare facility
Pass inspections related to safety, staffing, infection control, and building compliance

Step 2: CBAS Certification via CDA

Submit service delivery model, staff roster, care coordination plan, and sample documentation
Pass CBAS readiness review and receive certification

Step 3: Medi-Cal Enrollment (PAVE)

Apply through DHCS PAVE portal and submit required credentials, license, and NPI
Enroll with Managed Care Plans for contracts and referral access

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Fictitious Business Name (FBN)
IRS EIN Letter
NPI confirmation
CDPH ADHC license and CDA CBAS certification
Medi-Cal enrollment approval
Policy & procedure manual including:
- Participant intake, assessment, and care planning
- Nursing and therapy documentation standards
- Daily activity schedules and staff ratios
- HIPAA and client rights documentation
- Incident reporting and emergency protocols
- Interdisciplinary team meeting forms
- Billing logs, authorization records, and visit verification

6. STAFFING REQUIREMENTS

Required Roles:

Program Director (licensed professional)
Registered Nurse (RN)
Social Worker
Physical/Occupational/Speech Therapist (at least one discipline)
Activity Coordinator
Certified Nursing Assistants (CNAs) or Personal Care Assistants
Dietitian Consultant
Administrative Support Staff

Training Requirements for All Staff:

Person-centered planning and cultural sensitivity
Emergency response and first aid
HIPAA and confidentiality
Infection control, documentation, and client safety
Annual in-service training requirements per CDPH and CDA guidelines

7. MEDICAID WAIVER SERVICES

ADHC is reimbursed under:

Community-Based Adult Services (CBAS) Program
Medi-Cal Managed Care Plans (mandatory enrollment for most counties)
CalAIM Enhanced Care Management (ECM) and Community Supports (as coordinated)

Approved providers may deliver:

Individualized, center-based services per CBAS regulations
Skilled nursing and allied therapies
Behavioral and social support
Daily documentation and outcomes reporting
Transportation (if part of plan authorization)

8. TIMELINE TO LAUNCH

Phase: Business Formation

Timeline: 1–2 weeks

Phase: Facility Preparation and CDPH Licensing

Timeline: 90–150 days

Phase: CBAS Certification with CDA

Timeline: 60–90 days

Phase: Medi-Cal & Managed Care Enrollment

Timeline: 45–90 days

9. CONTACT INFORMATION

California Department of Aging – CBAS Program

Email: cbas@aging.ca.gov

Website: https://aging.ca.gov/Programs_and_Services/CBAS

California Department of Public Health (CDPH) – Licensing & Certification

Phone: (916) 558-1784

Website: https://www.cdph.ca.gov

California Department of Health Care Services (DHCS)

Website: https://www.dhcs.ca.gov

PAVE Provider Enrollment Portal

Website: https://pave.dhcs.ca.gov

Adult Day Health Care Services in California

WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — CALIFORNIA ADULT DAY HEALTH CARE (ADHC) PROVIDER

We help healthcare entrepreneurs and community organizations launch licensed Adult Day Health Care (ADHC) programs under California’s CBAS model, from facility planning to managed care contracting.

Scope of Work: