ADULT DAY HEALTH SERVICES PROVIDER IN HAWAII

ENHANCING WELL-BEING AND COMMUNITY PARTICIPATION THROUGH DAILY MEDICAL AND SUPPORT SERVICES

Adult Day Health Services (ADHS) in Hawaii provide structured, community-based programs offering health, therapeutic, and social services to individuals with disabilities, chronic illnesses, or aging-related needs. These services are authorized under Hawaii’s Medicaid Home and Community-Based Services (HCBS) waiver programs and Medicaid State Plan benefits, supporting independence while providing essential medical monitoring and social engagement.

1. GOVERNING AGENCIES

Agency: Hawaii Department of Human Services (DHS) — Med-QUEST Division

Role: Oversees Medicaid provider enrollment, service authorization, and reimbursement for Adult Day Health Services

Agency: Hawaii Department of Health (DOH) — Office of Health Care Assurance (OHCA)

Role: Licenses Adult Day Health centers and ensures regulatory compliance

Agency: Centers for Medicare & Medicaid Services (CMS)**Role: Provides federal oversight ensuring Adult Day Health Services meet Medicaid HCBS community integration and quality standards

2. ADULT DAY HEALTH SERVICE OVERVIEW

Adult Day Health Services are provided in a licensed, community-based setting and combine health services, therapeutic interventions, and social activities to maintain or enhance participants’ health and community living abilities.

Approved providers may deliver:

• Skilled nursing services (e.g., health monitoring, medication administration, wound care)

• Personal care assistance (e.g., toileting, eating, mobility support)

• Physical, occupational, and speech therapy (either on-site or through referrals)

• Structured social, educational, and recreational activities

• Nutritionally balanced meals and snacks

• Transportation services to and from the center (where authorized)

Programs must be individualized and based on each participant’s Individualized Service Plan (ISP), focusing on improving health outcomes, reducing isolation, and preventing institutionalization.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the Hawaii Department of Commerce and Consumer Affairs (DCCA)

• Obtain EIN from the IRS and NPI (Type 2)

• Obtain Adult Day Health Center License through Hawaii’s Office of Health Care Assurance (OHCA)

• Maintain general liability, professional liability, and workers’ compensation insurance

• Comply with applicable building safety codes, ADA accessibility requirements, and staffing ratios

4. MED-QUEST/DHS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Provider Enrollment Application for Adult Day Health Services through Hawaii’s Med-QUEST Division

• Submit a license application to OHCA for center operations

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, center floor plans, staffing rosters, insurance certificates, and operational policies

• Provide participant intake forms, care plans, therapy schedules, daily activity calendars, and emergency preparedness plans

Licensure and Readiness Review:

• Undergo an OHCA on-site inspection to verify facility compliance

• DHS reviews staffing, care delivery, participant protection systems, and Medicaid documentation practices

Approval & Medicaid Enrollment:

• Upon approval, configure billing codes for Adult Day Health attendance (half-day and full-day units)

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Hawaii DCCA)

• IRS EIN confirmation

• NPI confirmation

• Adult Day Health Center License (OHCA)

• Proof of general, professional, and workers’ compensation insurance

• HCBS-Compliant Policy & Procedure Manual including:

  • Participant intake, health assessment, and care planning procedures

  • Skilled nursing care, therapy services, and personal care assistance protocols

  • Daily programming, activity scheduling, and meal service guidelines

  • Emergency preparedness, evacuation, and disaster recovery procedures

  • HIPAA confidentiality, participant rights, and grievance policies

  • Staff credentialing, background checks, and training documentation

  • Medicaid billing, service tracking, and audit readiness procedures

6. STAFFING REQUIREMENTS

Role: Adult Day Health Program Administrator

Requirements: Bachelor’s degree in healthcare, human services, or related field; experience managing adult day or health services; background screening clearance

Role: Registered Nurse (RN) / Health Services Supervisor

Requirements: Active Hawaii RN license; experience in community health or geriatrics; background screening clearance

Role: Certified Nurse Aides (CNAs) / Direct Care Staff

Requirements: State certification preferred; CPR/First Aid certification; background screening clearance

Role: Activity Coordinators / Program Aides

Requirements: Experience with therapeutic recreation, social services, or education; background screening clearance

All staff must complete:

• HIPAA confidentiality, participant rights, and abuse prevention training

• Emergency preparedness and infection control training

• First aid, CPR, and medication administration (where applicable)

• Annual continuing education and competency evaluations

7. MEDICAID WAIVER PROGRAMS

The following Hawaii Medicaid programs authorize Adult Day Health Services:

• Community Care Services (CCS) Program

• Medicaid State Plan Long-Term Services and Supports (LTSS)

• Developmental Disabilities/Intellectual Disabilities (DD/ID) Waiver (community-based day services for certain participants)

Approved providers may deliver:

• Health monitoring, skilled nursing, and therapy integration

• Social and recreational programming to promote cognitive and emotional well-being

• Personal care services supporting daily living activities

• Nutritional support and participant safety monitoring

8. TIMELINE TO LAUNCH

Phase: Business Formation, Licensing, and Facility Preparation

Timeline: 2–4 months

Phase: Staffing, Training, and Program Development

Timeline: 2–3 months

Phase: Med-QUEST Enrollment and Medicaid Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing System Configuration and Claims Readiness

Timeline: 30–45 days

9. CONTACT INFORMATION

Hawaii Department of Human Services (DHS) — Med-QUEST Division

Website: https://medquest.hawaii.gov/

Hawaii Department of Health (DOH) — Office of Health Care Assurance (OHCA)

Website: https://health.hawaii.gov/ohca/

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — HAWAII ADULT DAY HEALTH SERVICES PROVIDER

WCG supports adult day health centers, healthcare agencies, and senior service organizations in launching Medicaid-compliant Adult Day Health Services under Hawaii’s HCBS waiver programs and Medicaid State Plan benefits.

​Scope of Work:

• Business registration and EIN/NPI setup

• Adult Day Health licensing and Medicaid provider enrollment support

• Development of Adult Day Health Services Policy & Procedure Manual

• Staff credentialing templates and participant intake/care planning forms

• Medicaid billing system setup and claims management

• Website, domain, and email setup

• Health monitoring, service documentation, and daily programming templates

• Emergency preparedness planning and incident reporting systems

• Quality assurance programs for participant safety, health outcomes, and satisfaction

• Community networking and referral development strategies

Continue To Our Client Portal To Get Started

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