ADULT DAY HEALTH SERVICES PROVIDER IN ILLINOIS

ENHANCING HEALTH, INDEPENDENCE, AND COMMUNITY ENGAGEMENT FOR ADULTS THROUGH DAYTIME SUPPORTIVE CARE

Adult Day Health Services (ADHS) in Illinois provide structured daytime programs offering health monitoring, therapeutic activities, personal care, and social engagement for adults with physical, cognitive, or medical needs. These services are authorized under Illinois Medicaid Waiver programs and the Community Care Program (CCP), helping participants remain in their homes and communities rather than entering institutional care.

1. GOVERNING AGENCIES

Agency: Illinois Department on Aging (IDoA)

Role: Oversees Adult Day Service providers under the Community Care Program (CCP) for older adults and coordinates program compliance and quality assurance

Agency: Illinois Department of Healthcare and Family Services (HFS)

Role: Administers Medicaid waiver funding for Adult Day Health Services and manages provider enrollment and billing systems

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring that Medicaid-funded Adult Day Health Services meet HCBS quality, safety, and community integration standards

2. ADULT DAY HEALTH SERVICE OVERVIEW

Adult Day Health Services provide medically supervised daytime care for individuals who need healthcare monitoring and assistance with daily living but do not require 24-hour skilled nursing.

Approved providers may deliver:

• Skilled nursing services such as medication administration, vital signs monitoring, and chronic disease management

• Assistance with Activities of Daily Living (ADLs) such as toileting, grooming, feeding, and mobility support

• Therapeutic and restorative activities (e.g., cognitive exercises, physical exercises, speech therapy)

• Nutritional services, including meals and special diet accommodations

• Socialization and recreation programs to reduce isolation

• Transportation coordination to and from the day health center

• Case management and family caregiver support services

All services must align with the participant’s individualized Service Plan and support goals related to maintaining health, independence, and quality of life.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business entity with the Illinois Secretary of State

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

• Apply for and obtain Adult Day Services Certification through IDoA (for CCP) or appropriate waiver program designation

• Enroll as a Medicaid waiver provider through the Illinois Medicaid Provider Enrollment Portal (IMPACT system)

• Obtain health and sanitation inspections/certifications for facility operations

• Maintain general and professional liability insurance

• Develop comprehensive policies for health services, participant protection, and documentation

• Ensure compliance with the Americans with Disabilities Act (ADA) accessibility standards

• Staff must meet all background screening, training, and licensure requirements

4. ILLINOIS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit an application to the Illinois Department on Aging or HFS, depending on the program (CCP vs waiver-funded Adult Day Health Services)

Application and Documentation Submission:

• Provide Articles of Incorporation, proof of EIN/NPI, facility floor plans, staffing plans, operational policies, insurance certificates, and health/sanitation permits

Program Readiness Review:

• State agencies conduct an on-site readiness inspection to evaluate facility safety, staffing ratios, service delivery models, participant protections, and compliance systems

Approval & Medicaid Enrollment:

• Upon approval, providers receive certification to deliver Adult Day Health Services and bill under Medicaid waiver programs using specific billing codes

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business Registration (Illinois Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Adult Day Services Certification (IDoA) or waiver-specific designation

• Health and sanitation inspection approvals

• Proof of general liability and professional liability insurance

• Adult Day Health Services Policy & Procedure Manual including:

  • Participant intake, assessment, and care planning processes

  • Health services delivery protocols and skilled nursing procedures

  • ADL assistance, emergency preparedness, and transportation coordination

  • Participant rights, grievance procedures, HIPAA compliance

  • Staff credentialing, background checks, training documentation

  • Billing and service tracking protocols for Medicaid compliance

6. STAFFING REQUIREMENTS

Role: Program Director / Administrator

Requirements: Bachelor’s degree in human services, healthcare, or a related field preferred; management experience in adult day or healthcare programs; background clearance

Role: Registered Nurse (RN)

Requirements: Active Illinois RN license; clinical supervisory responsibilities; background clearance

Role: Activity Coordinator / Recreation Therapist

Requirements: Certification or experience in therapeutic recreation preferred; background clearance

Role: Direct Care Workers / Program Aides

Requirements: High school diploma or GED; training in ADL assistance, first aid, CPR certification; background clearance

All staff must complete:

• Elder abuse prevention and mandatory reporting training

• HIPAA compliance and participant confidentiality training

• Emergency preparedness and infection control training

• Dementia care and person-centered service delivery training

• Annual competency assessments and ongoing professional development

7. MEDICAID WAIVER PROGRAMS

Adult Day Health Services are available under the following Illinois Medicaid programs:

• Community Care Program (CCP) — for individuals aged 60 and older

• Persons with Disabilities (PD) Waiver

• Persons with Brain Injury (BI) Waiver

• Supportive Living Program (SLP) (for enhanced day programming)

Approved providers may deliver:

• Nursing services and healthcare monitoring

• Therapeutic and restorative activities

• Daily meals and dietary accommodations

• Assistance with ADLs during program hours

• Social and recreational activities promoting mental and physical well-being

8. TIMELINE TO LAUNCH

Phase: Business Formation and Licensing Preparation

Timeline: 2–4 months

Phase: Facility Setup, Staffing, and Program Development

Timeline: 3–6 months

Phase: State Certification, Health Inspection, and Readiness Review

Timeline: 2–3 months

Phase: Medicaid Provider Enrollment and Billing Setup

Timeline: 60–90 days

Phase: Service Launch and Community Outreach

Timeline: 1–2 months

9. CONTACT INFORMATION

Illinois Department on Aging (IDoA) — Adult Day Services

Website: https://ilaging.illinois.gov/

Illinois Department of Healthcare and Family Services (HFS)

Website: https://www.hfs.illinois.gov/

Centers for Medicare & Medicaid Services (CMS)

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

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

WCG assists adult day health centers, supportive care agencies, and community-based organizations in launching Medicaid-compliant Adult Day Health Services in Illinois.

​​​​​​​​​​​​​​Scope of Work:

• Business registration, Adult Day Services Certification application, and Medicaid enrollment support

• Development of Adult Day Health Services Policy & Procedure Manual

• Staff credentialing templates, participant intake forms, and care plan templates

• Medicaid billing system setup and claims management assistance

• Website, domain, and professional marketing setup

• Facility setup consulting, including layout design for ADA accessibility and infection control

• Quality assurance program development and compliance tracking systems

• Community outreach, referral partnerships, and caregiver engagement strategies

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.