ADULT DAY HEALTH SERVICES PROVIDER IN WASHINGTON

Fatumata Kaba
2 hours ago
4 min read

OFFERING MEDICALLY SUPERVISED DAYTIME CARE TO PROMOTE HEALTH, ENGAGEMENT, AND INDEPENDENCE FOR OLDER ADULTS AND INDIVIDUALS WITH DISABILITIES

Adult Day Health (ADH) Services in Washington provide structured daytime care in a community-based setting for individuals who have chronic health conditions, physical or cognitive impairments, or need ongoing rehabilitation or nursing oversight. These programs support individuals’ ability to remain at home while receiving essential services like nursing care, therapy, and social engagement.

ADH is covered under Washington Apple Health (Medicaid) through the Community Options Program Entry System (COPES) Waiver, PACE (Program of All-Inclusive Care for the Elderly), and the Community First Choice (CFC) program. Oversight is provided by the Washington State Department of Social and Health Services (DSHS) and Health Care Authority (HCA).

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1. GOVERNING AGENCIES

Agency: Washington State Department of Social and Health Services (DSHS) – Aging and Long-Term Support Administration (ALTSA)

Role: Oversees licensing, service authorization, and care coordination for Medicaid clients receiving ADH.

Agency: Health Care Authority (HCA)

Role: Administers Apple Health, sets policy for Medicaid funding, and oversees Managed Care contracts.

Agency: Washington State Department of Health (DOH)

Role: Licenses ADH facilities under specific health care facility guidelines.

2. ADULT DAY HEALTH SERVICES OVERVIEW

Adult Day Health services integrate health, rehabilitation, and psychosocial services into a group setting during the day. These programs are ideal for individuals with complex care needs who live at home but require:

Nursing services
Medication management
Physical, occupational, or speech therapy
Social work or counseling
Daily health monitoring and chronic condition support
Nutritional counseling and meal services
Socialization and recreational activities

Each client must have a Person-Centered Service Plan (PCSP) developed in collaboration with a case manager and an interdisciplinary team.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business with the Washington Secretary of State
Obtain an EIN and Type 2 NPI
Apply for Adult Day Health Center licensure through the Washington Department of Health (DOH)
Enroll as a Medicaid provider via ProviderOne
Develop a comprehensive ADH Services Policy & Procedure Manual
Secure a facility that meets licensing and ADA accessibility standards
Complete background checks and credentialing for all staff

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI

Step 2: Secure a licensed, accessible facility with required medical and therapy equipment

Step 3: Apply for DOH Adult Day Health licensure

Step 4: Enroll in Medicaid via the ProviderOne portal

Step 5: Establish referral relationships with DSHS case managers

Step 6: Hire clinical, administrative, and program staff

Step 7: Begin services once a participant’s PCSP is approved

5. REQUIRED DOCUMENTATION

Secretary of State registration, EIN, and NPI
DOH ADH center license and fire safety inspection
Medicaid enrollment confirmation
ADH Policy & Procedure Manual including:
- Nursing and therapy protocols
- Medication administration records (MARs)
- Daily health tracking and incident reporting systems
- Client intake forms and PCSP tracking
- Staff orientation, training logs, and licensure verification
- Participant rights, HIPAA, and infection control
- Emergency response and evacuation plans
- Activity planning and meal tracking logs

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)Requirements:

Active Washington license
Oversees clinical care, medication management, and health monitoring

Role: Social Worker / Program Manager

Responsibilities:

Provides counseling, discharge planning, and support with psychosocial needs

Role: Therapists (PT, OT, SLP)Requirements:

Licensed in Washington; must document progress and therapy plans

Role: Activity Coordinator

Responsibilities:

Plans and facilitates meaningful group activities

Role: Direct Care Staff / Aides

Requirements:

CPR/First Aid certified; trained in ADL support and safety

All staff must complete:

TB testing and background checks
HIPAA and elder abuse prevention
Emergency preparedness training
Annual skills assessments and continuing education

7. MEDICAID PROGRAMS THAT COVER ADH

COPES Waiver – For individuals who meet the nursing facility level of care
Community First Choice (CFC) – May fund ADH for clients eligible for Apple Health and personal care
PACE Programs – Fully integrated Medicare-Medicaid models may provide ADH
Medically Needy Spenddown / State Plan Personal Care – For those who don’t qualify under a waiver but need services

Referrals and authorizations are coordinated through DSHS or MCOs, depending on the client’s coverage.

8. TIMELINE TO LAUNCH

Phase: Business Setup & Facility Preparation

Timeline: 1–2 months

Phase: DOH Licensing & Medicaid Enrollment

Timeline: 2–4 months

Phase: Staff Hiring & Training

Timeline: 4–6 weeks

Phase: Participant Intake & Service Launch

Timeline: Begins upon PCSP approval and team assignment

9. CONTACT INFORMATION

Washington State Department of Health (DOH)

Website: https://www.doh.wa.gov

Department of Social and Health Services (DSHS) – ALTSA

Website: https://www.dshs.wa.gov/altsa

Health Care Authority (HCA)

Website: https://www.hca.wa.gov

ProviderOne Medicaid Portal

Website: https://www.waproviderone.org

DSHS Long-Term Care Services Directory

Website: https://www.dshs.wa.gov/altsa/resources

ADULT DAY HEALTH SERVICES PROVIDER IN WASHINGTON

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

WCG supports new ADH providers in launching state-compliant centers with a focus on medical coordination, daily engagement, and regulatory excellence.

Scope of Work: