Adult Day Care Regulations in Alabama

Who regulates adult day care in Alabama

We found no Alabama agency that issues a license for adult day centers. The Alabama Department of Public Health (ADPH) Bureau of Health Provider Standards licenses and certifies health care facilities, and its list of facility rules covers 14 facility types, none of them adult day programs.

Oversight comes through Medicaid instead. The Alabama Department of Senior Services (ADSS) is the operating agency for the Elderly and Disabled (E&D) Waiver, which the Alabama Medicaid Agency administers. The waiver rules are in Chapter 560-X-36 of the Alabama Administrative Code, which describes the waiver as a cooperative effort between the two agencies.

Types of adult day programs in Alabama

The main program type defined in state rules is Medicaid Adult Day Health. Under Rule 560-X-36-.04, Adult Day Health "provides social and health care in a community facility approved to provide such care." The program must include health education, self-care training, therapeutic activities and health screening, and transportation between home and the center can be part of the service.

ADSS also lists adult day services, where available, among the services offered through its programs. We found no separate state definition of social adult day care.

Opening an adult day center in Alabama

Because we found no state adult day license, there is no state licensing application to file. The requirements below apply to centers that want to serve E&D Waiver participants.

1. Review the minimum standards for Adult Day Health Centers in Appendix C of the E&D Waiver, which Rule 560-X-36-.04 makes the provider standard.
2. Contact the contracting state agency. The state agencies that contract for Adult Day Health must determine that each facility meets the prescribed standards.
3. Make sure your setting meets the federal HCBS Settings Final Rule, as Rule 560-X-36-.01 requires.
4. Become a qualified enrolled provider. Waiver participants choose among qualified enrolled providers for each service in their plan of care.

Key requirements

• Service content: health education, self-care training, therapeutic activities and health screening must be part of the Adult Day Health program (Rule 560-X-36-.04).
• Setting: services must be in settings that are integrated in the community, chosen by the individual, respectful of privacy and autonomy, and supportive of choice. They may not be provided in nursing facilities, institutions for mental disease, ICFs for individuals with intellectual disabilities, hospitals or presumed institutional settings (Rule 560-X-36-.01).
• Plan of care: the case manager, the participant's physician and the participant or caregiver develop a written plan of care that lists services, providers and frequency, and no payment is made for services before the plan exists (Rule 560-X-36-.06).
• Oversight: the Alabama Medicaid Agency reviews a random sample of participants each month and can recoup payments when requirements are not met.

We could not open the waiver's Appendix C, so staffing, space and other center standards are not listed here. Ask the contracting agency for the current Adult Day Health Center standards.

Medicaid funding for adult day in Alabama

Alabama Medicaid covers Adult Day Health through the E&D Waiver, a Section 1915(c) waiver (AL.0068). Its current renewal took effect October 1, 2022 and runs through September 30, 2027 (E&D Waiver application). It serves people who would otherwise need nursing facility care and who meet Medicaid financial criteria, such as receiving SSI or qualifying under the special income level of 300 percent of the federal benefit rate (Rule 560-X-36-.02).

ADSS handles assessments for admissions and annual redeterminations. The Integrated Care Network (ICN), a 1915(b) primary care case management program run by the Alabama Medicaid Agency with Alabama Select Network, includes E&D Waiver participants. The ICN receives a monthly capitated payment that includes HCBS case management and reimburses the Area Agencies on Aging for that case management.

Billing basics

• Only services listed in the plan of care and the Services Authorization Form are reimbursable, and Medicaid recovers payments for services that are not listed (Rule 560-X-36-.01).
• Claims identify each service with an HCPC code, and payment is based on the units reported for each code (Rule 560-X-36-.09).
• Span billing can cover up to one month per recipient, but one claim cannot include services from different months.
• The rules we reviewed do not list the Adult Day Health procedure code or unit, so confirm them with the contracting agency.

Other ways centers are paid

Enrolled veterans who meet VA eligibility and clinical criteria can get Adult Day Health Care through the VA, which may be provided at VA medical centers, State Veterans Homes or community organizations.

Official resources

• ADSS Medicaid Waiver Programs
• Elderly and Disabled Waiver Application (AL.0068.R08.00)
• Ala. Admin. Code Chapter 560-X-36, Home- and Community-Based Services for the Elderly and Disabled
• ADPH Bureau of Health Provider Standards
• ADPH Health Care Facility Rules
• VA Adult Day Health Care

Frequently asked questions

Do I need a license to open an adult day center in Alabama?

We found no state adult day center license, and ADPH's facility rules do not cover adult day programs. To serve E&D Waiver participants, a center must meet the waiver's Adult Day Health Center standards, as determined by the contracting state agency.

Does Alabama Medicaid pay for adult day care?

Yes. Adult Day Health is a covered service in the Elderly and Disabled Waiver, which ADSS operates for people who would otherwise need nursing facility care.

Is social adult day care regulated in Alabama?

We found no Alabama rule that licenses or defines social adult day care. The state rules we found apply to Adult Day Health for Medicaid waiver participants.

Who oversees adult day health providers in Alabama?

The state agencies that contract for Adult Day Health must confirm that each facility meets the waiver standards. The Alabama Medicaid Agency also reviews a monthly sample of participants and can recoup payments.