ADULT DAY SERVICES PROVIDER IN IDAHO

SUPPORTING SOCIALIZATION, HEALTH, AND DAILY LIVING SKILLS IN A COMMUNITY-BASED SETTING

Adult Day Services in Idaho offer structured programming during daytime hours for individuals with disabilities, chronic illnesses, or aging-related needs. These services are authorized under Idaho’s Medicaid Home and Community-Based Services (HCBS) waiver programs and Medicaid State Plan options, supporting community living, preventing isolation, and providing respite for caregivers.

1. GOVERNING AGENCIES

Agency: Idaho Department of Health and Welfare (IDHW) — Division of Medicaid

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

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring Adult Day Services meet Medicaid HCBS standards for community integration, participant rights, and person-centered care

2. ADULT DAY SERVICE OVERVIEW

Adult Day Services provide supervised, structured care and support outside the participant's home in a licensed or certified facility, enhancing quality of life and promoting independence.

Approved providers may deliver:

• Assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)

• Health monitoring (basic, non-invasive checks under non-nursing supervision)

• Structured recreational, social, and educational activities

• Nutritional services, including meals and snacks

• Community outings and integration activities

• Personal care, medication reminders (non-skilled), and mobility assistance

• Respite and caregiver support services

Programs are individualized based on each participant’s needs and preferences as outlined in their Individualized Service Plan (ISP).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the Idaho Secretary of State

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

• Enroll as a Medicaid provider through Idaho Medicaid Provider Enrollment

• Obtain local permits if operating a facility (building safety, health, and occupancy compliance)

• Maintain general liability and professional liability insurance

• Develop operational policies ensuring participant safety, service delivery, and emergency preparedness

4. IDHW PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Provider Enrollment Application for Adult Day Services through Idaho’s Medicaid Management Information System (MMIS)

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, staff qualifications, operational policies, and insurance certificates

• Provide facility floor plans, activity schedules, participant intake forms, and emergency plans

Program Readiness Review:

• IDHW reviews provider readiness, including facility safety compliance, staff qualifications, Medicaid billing systems, and participant rights policies

Approval & Medicaid Enrollment:

• Upon approval, configure billing codes for Adult Day Services (typically billed hourly or daily)

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Idaho Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Proof of general and professional liability insurance

• HCBS-Compliant Policy & Procedure Manual including:

  • Participant intake, assessment, and activity planning procedures

  • ADL support, mobility assistance, and medication reminder protocols

  • Safety plans for emergencies, disasters, and participant health crises

  • HIPAA confidentiality, participant rights, and grievance handling procedures

  • Staff credentialing, background checks, and ongoing training documentation

  • Medicaid billing, daily attendance tracking, and audit readiness systems

6. STAFFING REQUIREMENTS

Role: Adult Day Program Manager / Administrator

Requirements: Experience in human services, healthcare, or senior services; background screening clearance

Role: Direct Support Staff / Activity Coordinators

Requirements: High school diploma or GED; CPR/First Aid certification; training in personal care assistance and activity facilitation; background screening clearance

All staff must complete:

• HIPAA confidentiality and participant rights training

• Emergency preparedness, infection control, and abuse prevention training

• Participant-centered planning and community integration training

• Annual refreshers on safety protocols and Medicaid compliance

7. MEDICAID WAIVER PROGRAMS

The following Idaho Medicaid Waivers authorize Adult Day Services:

• Aged and Disabled (A&D) Waiver

• Developmental Disabilities (DD) Waiver (for community-based day supports)

Approved providers may deliver:

• Daytime supervision and skill-building supports

• Structured activities promoting socialization and life skills

• Basic health monitoring and personal assistance during program hours

8. TIMELINE TO LAUNCH

Phase: Business Formation and Facility Setup

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development

Timeline: 1–2 months

Phase: Idaho Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing System Configuration and Claims Readiness

Timeline: 30–45 days

9. CONTACT INFORMATION

Idaho Department of Health and Welfare (IDHW) — Medicaid Division

Website: https://healthandwelfare.idaho.gov/services-programs/medicaid-health

Centers for Medicare & Medicaid Services (CMS)

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

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

WCG supports adult day centers, community-based organizations, and disability service providers in launching Medicaid-compliant Adult Day Services under Idaho’s HCBS waiver programs.

Scope of Work:

• Business registration and EIN/NPI setup

• Facility setup and compliance guidance

• Medicaid provider enrollment assistance

• Development of Adult Day Services Policy & Procedure Manual

• Staff credentialing templates and participant intake/activity planning forms

• Medicaid billing system setup and claims management

• Website, domain, and email setup

• Daily service tracking, incident reporting, and emergency management templates

• Quality assurance programs for participant safety, satisfaction, and community engagement

• Outreach strategies to build referral networks and community partnerships

Continue To Our Client Portal To Get Started

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