Adult Day Care Regulations in Missouri

Who regulates adult day care in Missouri

The Missouri Department of Health and Senior Services (DHSS) licenses adult day care programs under sections 192.2200 to 192.2260, RSMo and the licensure rules in 19 CSR 30-90. The rules were last amended effective March 30, 2005.

Medicaid in Missouri is MO HealthNet, run by the Department of Social Services, MO HealthNet Division. The DHSS Division of Senior and Disability Services administers the waivers that pay for adult day care.

Types of adult day programs in Missouri

• Adult day care program: a group program that provides care and supervision to five or more functionally impaired adults for more than two hours but less than 24 hours a day, outside their own homes (19 CSR 30-90.010).
• Associated program: an adult day care program in a building also occupied by a long-term care or medical facility, with its own designated space and staff.
• Adult day health care: the licensing rules define this as a program certified for Medicaid-reimbursed services under a MO HealthNet rule. That MO HealthNet rule (13 CSR 70-92.010) was rescinded effective December 30, 2015.

Some programs are exempt unless they choose to be licensed, including programs that provide care for two hours a day or less, programs caring for four or fewer unrelated people, federal programs, programs licensed by the Department of Mental Health that serve only people with mental illness or developmental disabilities, and religious not-for-profit programs with a social or religious purpose that offer no medical or therapeutic services (19 CSR 30-90.020).

How to get licensed in Missouri

1. Submit a DHSS license application signed and notarized by the owner, board chair or chief executive officer, with the nonrefundable fee, which depends on licensed capacity. Programs with an Alzheimer's special care unit also file a disclosure form.
2. DHSS reviews the application and investigates the applicant and program to confirm they comply with the rules.
3. Get annual fire approval from the local fire authority and meet the fire safety and physical plant rules in 19 CSR 30-90.070.
4. DHSS issues a regular license for up to two years, or a nonrenewable provisional license for up to six months if the program can reach compliance.
5. Renew on time: renewal applications must be postmarked at least 30 days before the license expires. A license does not transfer to a new owner or a new location.

The division may grant written exceptions to rules for set periods when participants' health, safety and welfare are not endangered.

Key requirements

• Staffing ratio: at least two direct care staff when 2 to 16 participants are present, plus one more for each additional group of up to eight participants. The director or a designee must be on site whenever participants are present (19 CSR 30-90.040).
• Nursing: if the program offers medical services, a licensed nurse must be available whenever it operates, and only a licensed nurse may manage medications.
• First aid and training: at least one staff member certified in first aid and CPR must be on site at all times. Staff get orientation before working and in-service training at least quarterly, with dementia training for staff caring for people with dementia.
• Screening: check the Employee Disqualification List at least every 90 days.
• Space: 80 square feet per participant for up to 20 participants, plus 50 square feet for each additional participant, not counting offices, bathrooms, storage, exam rooms or dining rooms unless used for activities (19 CSR 30-90.070).
• Facilities: one toilet and hand-washing sink for every ten participants, a quiet rest area with at least one bed, room temperatures between 68 and 85 degrees, and monthly fire drills.

Medicaid funding for adult day in Missouri

MO HealthNet lists adult day care under two 1915(c) home and community-based waivers operated by DHSS:

• Adult Day Care Waiver: for adults with disabilities ages 18 through 63 who meet nursing facility level of care. It pays for continuous supervision and care in a licensed adult day care setting, including help with daily activities, group activities, food service, observation, skilled nursing under the plan of care, and transportation to and from the center.
• Aged and Disabled Waiver: for people 63 and older who would need nursing home care without these services. Its services include homemaker, chore, respite, home-delivered meals and adult day care.

Billing basics

MO HealthNet requires electronic claim submission (13 CSR 70-3.160), and claims must reach the state within 12 months of the date of service (13 CSR 70-3.100). MO HealthNet's provider web portal is eMOMED. DSS posts an Adult Day Care Waiver Provider Manual on the waiver page.

The MO HealthNet electronic visit verification (EVV) page applies EVV to personal care and home health care services. It does not mention adult day 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

• 19 CSR 30-90, Adult Day Care Program Licensure
• Section 192.2200, RSMo (definitions)
• Missouri Department of Health and Senior Services
• MO HealthNet 1915(c) Home and Community Based Waivers
• Adult Day Care Waiver
• Aged and Disabled Waiver
• MO HealthNet Provider Information
• National Adult Day Services Association

Frequently asked questions

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

Yes, if your program provides care and supervision to five or more functionally impaired adults for more than two hours a day. DHSS issues the license under 19 CSR 30-90.

Does Missouri Medicaid pay for adult day care?

Yes. MO HealthNet pays for adult day care through the Adult Day Care Waiver (ages 18 through 63) and the Aged and Disabled Waiver (ages 63 and older), both administered by DHSS.

How long is a Missouri adult day care license valid?

A regular license lasts up to two years. A provisional license lasts up to six months and cannot be renewed.

Is social adult day care regulated in Missouri?

Programs that serve five or more functionally impaired adults for more than two hours a day need a license. Religious not-for-profit programs with a social or religious purpose that offer no medical or therapeutic services are exempt unless they choose to be licensed.