Adult Day Care Regulations in Hawaii

Who regulates adult day care in Hawaii

Hawaii has two separately regulated adult day settings, and both fall under the Department of Health, Office of Health Care Assurance (OHCA). OHCA's Medicare Section licenses adult day health centers under HAR Chapter 11-96, Freestanding Adult Day Health Centers (adopted 1991). OHCA's State Licensing Section regulates adult day care centers and has designated Community Ties of America to handle their licensing and certification.

Adult day care centers are governed by HAR Chapter 17-1424, Licensing of Adult Day Care Centers (effective October 2001), which the Department of Health lists among its current rules. Medicaid is run by the Department of Human Services, Med-QUEST Division, through its QUEST Integration health plans.

Types of adult day programs in Hawaii

• Adult day health center: an organized day program of therapeutic, social and health services for adults with physical or mental impairments who need nursing oversight or care (HAR 11-96-2).
• Adult day care center: a facility providing regular supportive care to four or more disabled adult participants (HAR 17-1424-2). The chapter does not apply to programs run solely for education, social or recreational purposes, or to facilities licensed by the Department of Health as adult day health facilities.

How to get licensed in Hawaii

For an adult day health center, OHCA's opening an adult day health center page lists these steps:

1. Obtain an approved certificate of need from the State Health Planning and Development Agency (SHPDA), or a SHPDA letter stating one is not needed.
2. Send the SHPDA response and a written licensure request to OHCA, with your policy and procedure manual, contracts, staff licenses and credentials, legal name and tax ID, address, days and hours, and administrator contact details.
3. OHCA acknowledges the application and schedules an initial on-site survey. OHCA notes it may have a backlog of several months.

Adult day health licenses run for one year, and inspections occur at least yearly (HAR 11-96-3). For an adult day care center, HAR 17-1424 requires a certificate of approval, valid for up to 24 months, with renewal applications due at least 30 days before expiration.

Key requirements

Adult day health centers (HAR 11-96):

• Nursing services under the supervision of a registered nurse (RN), who completes each client's nursing assessment and plan of care (11-96-25).
• Staffing sufficient to carry out daily activities, nursing services, physician orders and individual plans of care, with at least one staff member trained in CPR and first aid present at all times (11-96-39, 11-96-13).
• A full-time program director in addition to the administrator once capacity reaches 50 clients (11-96-4).
• At least 50 square feet of recreation and dining space per client and one toilet room for every 12 clients (11-96-30).

Adult day care centers (HAR 17-1424):

• At least one regular staff member for every six participants, not counting volunteers (17-1424-12).
• At least one staff member certified in first aid and CPR on site while participants are present (17-1424-12).
• At least 50 square feet per person for recreation, rest and dining, and one toilet and one wash basin for every 10 persons or fraction of 10, for each sex (17-1424-17).

Medicaid funding for adult day in Hawaii

QUEST Integration is a Section 1115 demonstration run by the Department of Human Services, Med-QUEST Division, and it uses capitated managed care plans as its delivery system. Its benefits include institutional and home and community-based long-term services and supports.

Med-QUEST's QUEST Integration benefits page lists adult day care and adult day health among the home and community-based services available as long-term services and supports. It states that the health plan provides these services to members who meet the appropriate level of care, based on a physician's evaluation. Centers serving QUEST Integration members therefore work with the member's health plan.

Billing basics

Because the health plans are responsible for these services, check each QUEST Integration plan's provider requirements for authorization and billing. No official Med-QUEST fee schedule or billing guide for adult day was reviewed, so procedure codes are not listed here.

Med-QUEST's electronic visit verification (EVV) page says EVV applies to some home and community-based services and links a table of affected services. The page itself does not mention adult day.

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

• Office of Health Care Assurance
• Opening an Adult Day Health Center
• OHCA State Licensing Section
• HAR Chapter 11-96, Freestanding Adult Day Health Centers
• HAR Chapter 17-1424, Licensing of Adult Day Care Centers
• QUEST Integration Benefits
• Med-QUEST Electronic Visit Verification

Frequently asked questions

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

Yes, for most programs. A freestanding adult day health center needs a Department of Health license under HAR 11-96, and an adult day care center serving four or more disabled adults needs a certificate of approval under HAR 17-1424.

Is social adult day care regulated in Hawaii?

HAR 17-1424 does not apply to programs run solely for education, social or recreational purposes. Centers that provide regular supportive care to four or more disabled adults are covered.

Does Hawaii Medicaid pay for adult day care?

Yes. QUEST Integration lists adult day care and adult day health as home and community-based services that health plans provide to members who meet the appropriate level of care.

Who inspects adult day centers in Hawaii?

OHCA's Medicare Section surveys adult day health centers at least yearly. Adult day care centers are regulated by OHCA's State Licensing Section, which has designated Community Ties of America for their licensing and certification.