Adult Day Care Regulations in Connecticut

Who regulates adult day care in Connecticut

Connecticut sets its adult day standards through the Connecticut Home Care Program for Elders (CHCPE), a Department of Social Services (DSS) program. The program's regulations, Regs. Conn. State Agencies 17b-342-1 to 17b-342-5, define adult day health services and the requirements a center must meet to be paid.

Under section 17b-342-2 (last amended in 2010), an in-state center must be certified by the Connecticut Association of Adult Day Centers, Inc., its successor agency or a department designee. Centers must also meet all applicable federal, state and local requirements, including zoning, licensing, sanitation, fire and safety rules. Confirm with DSS which body certifies centers today.

Types of adult day programs in Connecticut

The regulations describe adult day health services as a community-based program designed to meet the needs of cognitively and physically impaired adults. They recognize two models:

• Social model: programs that meet the general adult day requirements described below.
• Medical model: programs that also show DSS they meet extra nursing, personal care, training and therapy requirements, and are paid at the medical model rate.

How to get certified in Connecticut

Section 17b-342-2 lists what a center needs in order to be paid under CHCPE:

1. Meet all applicable federal, state and local requirements, including zoning, licensing, sanitation, fire and safety rules.
2. Provide nursing consultation, social work, meals, personal care, recreational therapy and transportation, with adequate personnel.
3. Obtain certification from the Connecticut Association of Adult Day Centers, Inc., its successor agency or a department designee (per the 2010 regulation; confirm the current certifying body with DSS). Facilities in bordering states must be licensed or certified by their own state and meet the DSS certification standards.
4. To receive the medical model rate, demonstrate to DSS that the program meets the additional medical model requirements.

Failing to meet the requirements is grounds for termination of certification and of participation as a DSS provider. Under section 17b-342-1, access agencies assess clients, develop plans of care that DSS authorizes, and arrange services with providers.

Key requirements

For every adult day health program paid under CHCPE (section 17b-342-2, effective July 8, 1998, amended September 3, 2010):

• A full-time program administrator.
• Nursing consultation during the full operating day by a registered nurse licensed in Connecticut.
• A direct care staff-to-participant ratio of at least one to seven.

For the medical model rate, the regulation adds:

• A program nurse on site for at least 50 percent of each operating day. The program nurse must be an RN, except that an LPN may serve when the program is in a hospital or long term care facility licensed by the Department of Public Health with ready access to an RN, or when an RN supervisor can be reached by phone at any time during the operating day and can come to the center within half an hour.
• Additional personal care, such as bathing and transferring, as specified in each participant's plan of care.
• Ongoing staff training, including orientation to physical, occupational and speech therapy.
• Coordination of individual therapy and rehabilitation services in the plan of care, with the capacity to provide them on site.

Medicaid funding for adult day in Connecticut

CHCPE lists adult day health services among its covered services. Section 17b-342-1 (as amended in 2010) says the program is funded under a Medicaid waiver and by an appropriation from the General Assembly. DSS's current fact sheet describes two funding types: Medicaid waiver-funded and state-funded services.

Applicants must be 65 or older, live in Connecticut, be at risk of nursing home placement and meet financial criteria. The DSS CHCPE fact sheet says applicants generally need help with at least three activities of daily living, or with two plus a specific need factor such as medication assistance.

Billing basics

Under section 17b-342-2, payment for adult day services includes transportation, meals and all other required services. Individual therapy and rehabilitation services are not part of the adult day payment. For CHCPE participants in assisted living, adult day services are included in the monthly assisted living rate.

As written in 2010, section 17b-342-1 has access agencies subcontract with providers for the services in each plan of care and submit claims through the DSS claims processing agent. DSS authorizes each plan of care.

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

• DSS: Connecticut Home Care Program for Elders
• Regs. Conn. State Agencies 17b-342-1 to 17b-342-5
• DSS: About Home and Community-Based Services
• DSS: Electronic Visit Verification

Frequently asked questions

Do I need a license or certification to open an adult day center in Connecticut?

Section 17b-342-2 (last amended in 2010) requires a center paid through CHCPE to be certified by the Connecticut Association of Adult Day Centers, Inc., its successor agency or a department designee, and to meet all applicable federal, state and local requirements, including zoning, licensing, sanitation, fire and safety rules. Confirm with DSS which body certifies centers today.

Does Connecticut Medicaid pay for adult day care?

Yes. CHCPE covers adult day health services and is funded by a Medicaid waiver and by state funds. DSS authorizes each participant's plan of care.

What is the difference between social model and medical model adult day in Connecticut?

Both must meet the general CHCPE requirements, including a full-time administrator, RN nursing consultation and a staff ratio of at least one to seven. Medical model programs also keep a program nurse on site at least half of each operating day, meet other added requirements, and are paid at the medical model rate.