Adult Day Care Regulations in Maine

Who regulates adult day care in Maine

The Maine Department of Health and Human Services (DHHS), Division of Licensing and Certification licenses adult day services programs through its Assisted Housing unit. State law, 22 M.R.S. Chapter 1679, bars anyone from operating an adult day care program without a DHHS license.

The detailed rules are in 10-144 CMR Chapter 117, Regulations Governing the Licensing and Functioning of Adult Day Services Programs, last amended effective January 4, 2006. MaineCare, the state Medicaid program, is run by the DHHS Office of MaineCare Services, and the Office of Aging and Disability Services (OADS) oversees state-funded adult day assistance.

Types of adult day programs in Maine

Chapter 117 licenses two program types, and one provider can hold both if records are kept distinct.

• Social Adult Day Services Program: meets participants' social and supervisory needs with supervision, activities, help with activities of daily living, and morning and afternoon refreshments.
• Adult Day Health Services Program: adds health monitoring, more extensive personal care, at least one meal, medication administration, and nursing services by a registered nurse (RN) or licensed practical nurse (LPN).
• Night Program: offered between 5 PM and 7 AM for consumers with dementia who are awake during some of those hours. It requires separate approval.

How to get licensed in Maine

DHHS takes applications online through its Assisted Housing page, and the license must be issued before you open. Under Chapter 117, Section 2, an initial application includes:

1. The application form and the nonrefundable fee, based on licensed capacity.
2. Written policies on refunds, complaint resolution, medication administration, confidentiality and admissions.
3. Proof of liability and property damage insurance, plus vehicle insurance if you provide transportation.
4. Floor plans showing at least 50 square feet of program space per consumer.
5. A letter from a local municipal official confirming compliance with local codes, and a posted emergency plan.

Under 22 M.R.S. Section 8605, DHHS cannot grant full licensure until it receives a written fire safety statement from the Commissioner of Public Safety. If DHHS and Public Safety have not completed inspections within 90 days of a complete application, the rule provides for a provisional license. Licenses are renewed yearly, with renewal applications due at least 30 days before expiration.

Key requirements

• Staffing ratio: at least one staff member for every six consumers at all times consumers are present. Programs with three to six consumers must have a second staff person on call for emergencies (Section 5.3).
• Administrator: at least 21, with management or supervisory experience (Section 4.1.1).
• Training: orientation for new staff and volunteers, then 6 hours a year for those working 20 hours a week or less and 12 hours for those working more (Section 5.5).
• Space: at least 50 square feet of program activity space per consumer (Section 2.4.1).
• Nursing: adult day health programs must provide nursing services by an RN or LPN (Section 9.4.1.3).
• Hours: no program may serve a consumer for 24 consecutive hours (Section 9.6).
• Background checks: required for direct access personnel under 22 M.R.S. Section 8606.

Medicaid funding for adult day in Maine

MaineCare covers adult day health under MaineCare Benefits Manual, Chapter II, Section 26, Day Health Services. Services are delivered at a licensed site under an individual plan of care and include health monitoring, nursing, rehabilitation, counseling and meals.

Members must meet financial eligibility and one of three medical levels, assessed by DHHS or its authorized agent with the Medical Eligibility Determination (MED) form. Weekly limits are 16 hours at Level I, 24 at Level II and 40 at Level III. MaineCare pays the center directly, at the lower of its usual and customary charge or the Chapter III, Section 26 allowance. DHHS posts Section 26 rate notices on its Medicaid State Plan page.

Billing basics

Section 26 requires providers to bill according to the Department's billing instructions. Day Health Services are billed under procedure code S5100 with modifier HC. Chapter III, Section 26 (rates last shown for July 2019) lists a 15-minute unit, but a later DHHS rate notice may use a different unit, so confirm the current unit and rate on the MaineCare fee schedule before billing.

Prior authorization and reassessment are required for all members. Request a reassessment no more than 14 days before the reclassification date, since coverage ends with the classification period unless a new one is authorized.

Maine's electronic visit verification (EVV) guidance covers personal care and home health services that require in-home visits. Section 26 Day Health Services is not on its list of affected sections, and the guidance does not mention adult day.

Other ways centers are paid

The OADS Policy Manual (10-149 CMR Chapter 5) sets out state-funded options:

• Section 61, Adult Day Services: helps adults 18 and older who cannot afford a licensed program and are not eligible for certain MaineCare programs. Under the 1997 Section 61 rule text, consumers generally pay 20 percent of the cost unless it is waived.
• Section 63, Home-Based Supports and Services: a state-funded program that covers adult day services from licensed and certified providers.
• Section 68, Respite Care for Adults with Alzheimer's Disease or Related Disorders: respite may be provided in a licensed adult day program.

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

• DHHS Division of Licensing and Certification: Assisted Housing
• 10-144 CMR Chapter 117 (adult day licensing rules)
• 22 M.R.S. Chapter 1679, Adult Day Care Program
• MaineCare Benefits Manual, Chapter II, Section 26
• MaineCare Benefits Manual, Chapter III, Section 26
• OADS Adult Day Services
• OADS Policy Manual, 10-149 CMR Chapter 5
• MaineCare Electronic Visit Verification

Frequently asked questions

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

Yes. State law requires a DHHS license to operate an adult day care program, and Chapter 117 applies to any program serving more than two consumers.

Is social adult day care regulated in Maine?

Yes. Social Adult Day Services Programs are licensed under the same Chapter 117 rules as Adult Day Health Services Programs, including the 1:6 staffing ratio.

Does MaineCare pay for adult day care?

Yes. MaineCare covers Day Health Services under Section 26 for eligible members, with prior authorization. State-funded programs under OADS Sections 61, 63 and 68 can also pay.

Who inspects adult day centers in Maine?

The DHHS Division of Licensing and Certification inspects licensed programs and may enter a licensed site at any time to check compliance. A fire safety statement from the Commissioner of Public Safety is required before full licensure.