Adult Day Care Regulations in New Jersey

Who regulates adult day care in New Jersey

The New Jersey Department of Health (DOH) licenses adult day health services facilities, also called medical day care, under N.J.A.C. 8:43F. The rules apply to every facility that provides adult day health services, regardless of who pays. A facility that is a Medicaid provider must also follow the Medicaid rules at N.J.A.C. 10:164, which the Department of Human Services lists under its Division of Aging Services.

Social adult day care (SADC) is handled differently. DOH's facility types list does not include it, and the Medicaid MLTSS Service Dictionary leaves its licensing entity and regulation fields blank.

Types of adult day programs in New Jersey

• Adult day health services (medical day care): DOH describes these as preventive, diagnostic, therapeutic and rehabilitative services under medical and nursing supervision for functionally impaired adults, for no more than 12 hours a day.
• Social adult day care: the MLTSS Service Dictionary describes SADC as a community-based group program designed to meet the nonmedical needs of adults in a protective setting. An MLTSS member cannot combine SADC with adult day health services.

How to get licensed in New Jersey

Under subchapter 2 of N.J.A.C. 8:43F, the main steps are:

1. Apply on the forms DOH prescribes and show the capacity to operate, including premises, equipment, personnel, finances, rules and health care standards. DOH also reviews the applicant's track record.
2. Obtain criminal background clearance for current or prospective owners and administrators. DOH will not issue or continue a license without it.
3. When the application is approved and the building is ready, DOH may survey the facility. Deficiencies must be corrected, with resurveys before occupancy.
4. Wait for the license before admitting participants. A license runs for one year, is renewed annually, must be posted, and cannot be transferred. It becomes void if the facility stops operating, changes ownership or moves.

After licensure, DOH representatives may make survey visits at any time. When they find problems, they may request a plan of correction.

Key requirements

Adult day health services (N.J.A.C. 8:43F, readopted effective November 18, 2021):

• Operate at least five consecutive hours and no more than 12 hours a day, not counting transportation, at least five days a week (8:43F-6.1).
• Provide nursing, dietary, activities, pharmaceutical and social work services directly; provide or arrange occupational, physical and speech-language therapy; and make dental, laboratory, medical and radiological referrals (8:43F-6.1).
• Keep at least one full-time or full-time equivalent direct care staff member for every nine participant equivalents, based on the daily census. Time spent driving participants never counts toward the ratio (8:43F-6.2).
• Designate a registered professional nurse as director of nursing services, on duty whenever participants are present, plus an RN to act in the director's absence. When daily attendance exceeds 60, additional licensed nursing staff must be present (8:43F-7.1).

Social adult day care for MLTSS members (MLTSS Service Dictionary): the service runs at least five consecutive hours a day, excluding transportation, up to five days a week. Requirements include a license or occupancy permit, police and fire department response agreements, a program director, a nurse consultant, written safety policies and at least one nutritionally balanced meal a day.

Medicaid funding for adult day in New Jersey

New Jersey Medicaid (NJ FamilyCare) delivers long term services and supports through Managed Long Term Services and Supports (MLTSS), coordinated by NJ FamilyCare managed care organizations. CMS authorizes MLTSS under the NJ FamilyCare Comprehensive Demonstration, a Section 1115 demonstration approved from April 1, 2023 through June 30, 2028. Adults 21 and older must meet Medicaid financial rules and nursing facility level of care, and be 65 or older or determined blind or disabled.

N.J.A.C. 10:164 (last amended in 2009, before MLTSS began) sets Medicaid's rules for adult day health services, including prior authorization and a Department-set per diem. Most NJ FamilyCare members are now enrolled in managed care, so confirm with DMAHS and each NJ FamilyCare MCO whether the plan or fee-for-service Medicaid authorizes and pays for medical day care for a given member.

Billing basics

For MLTSS social adult day care, the MLTSS Service Dictionary and the DMAHS MLTSS billing code crosswalk list HCPCS code S5102 with modifier U3 (day care services, adult; per diem).

For adult day health services, N.J.A.C. 10:164 says the per diem covers all services required for licensure, except physical, occupational and speech-language therapies, which are billed separately. Medicaid does not pay for adult day health services on the same day as partial care or partial hospitalization.

Other ways centers are paid

The Division of Aging Services runs two state programs that pay for adult day. The Alzheimer's Adult Day Services Program subsidizes adult day care for people with Alzheimer's disease or a related dementia at contracted centers that offer at least a five-hour program day and dementia training for staff. Jersey Assistance for Community Caregiving (JACC), a state-funded program, lists adult day health services and social adult day care among its services. Enrolled veterans who meet VA eligibility and clinical criteria can get adult day health care through the VA (VA Adult Day Health Care).

Official resources

• N.J.A.C. 8:43F, Standards for Licensure of Adult Day Health Services Facilities
• N.J.A.C. 10:164, Adult Day Health Services
• NJ DOH Certificate of Need and Facility Licensing
• NJ FamilyCare Managed Long Term Services and Supports
• MLTSS Service Dictionary
• NJ Division of Aging Services
• New Jersey Adult Day Services Association

Frequently asked questions

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

Yes, to provide adult day health services (medical day care). N.J.A.C. 8:43F requires a DOH license for any facility providing these services, regardless of payment source, and no participants may be admitted until the license is issued.

Who inspects adult day centers in New Jersey?

DOH may survey a facility before licensure and may make survey visits at any time afterward. It can request a plan of correction when it finds problems.

Is social adult day care regulated in New Jersey?

DOH's facility types list does not include social adult day care. SADCs that serve MLTSS members must meet the MLTSS Service Dictionary requirements, and centers in the Alzheimer's Adult Day Services Program fall under N.J.A.C. 10:164A.

Does New Jersey Medicaid pay for adult day care?

Yes. N.J.A.C. 10:164 sets Medicaid rules for adult day health services, and MLTSS plans cover social adult day care. Confirm the medical day care payer with DMAHS or the member's MCO.