Adult Day Care Regulations in New Hampshire

Who regulates adult day care in New Hampshire

The New Hampshire Department of Health and Human Services (DHHS) licenses adult day programs (ADPs) under RSA 151 and its rule He-P 818, Adult Day Programs, which sits in the He-P 800 Residential Care and Health Facility Rules. RSA 151:2 requires a license for adult day care services that offer medical supervision, care or treatment, or help with activities of daily living, to 3 or more people. Medicaid coverage is governed by separate DHHS rules in Chapter He-E 800, Medical Assistance: He-E 803 for adult medical day services and He-E 801 for the Choices for Independence (CFI) waiver.

The DHHS Adult and Aging Care pages direct people who need long-term supports, such as home and community based care, to ServiceLink Resource Centers and DHHS district offices. The CFI rule also refers to the state registry maintained by the DHHS Bureau of Elderly and Adult Services (BEAS), which providers must check before and during employment.

Types of adult day programs in New Hampshire

• Adult day program (ADP): the licensed setting. The CFI rule defines adult day services as services delivered by a facility licensed under He-P 818 for fewer than 12 hours a day. He-P 818 has a separate section for ADPs located in senior centers, nursing homes, assisted living residences (residential care) and supported residential health care facilities.
• Adult medical day services: the Medicaid-reimbursed service governed by He-E 803, Adult Medical Day Care Services. The CFI definition of adult day services includes adult medical day services.

How to get licensed in New Hampshire

He-P 818 lays out the licensing process in dedicated sections: initial license application requirements (He-P 818.04), processing of applications and issuance of licenses (818.05), license expirations and renewals (818.06), construction, modifications or renovations (818.07), organizational changes (818.08), inspections (818.09) and waivers (818.10). The current official text of each section controls what your application must contain.

A license alone does not let you bill Medicaid. CFI providers must also enroll in NH Medicaid as a CFI provider, and programs that bill for adult medical day services must meet the provider requirements in He-E 803.

Key requirements

He-P 818 covers the duties of all licensees, required services, care requirements, medication services, personnel, quality improvement, infection control, sanitation, physical environment, fire safety and emergency preparedness. The CFI rule adds these conditions for Medicaid participation:

• Adult day services must be delivered by an ADP licensed under RSA 151:2 and He-P 818 (He-E 801.15).
• Adult day providers must follow the provider and documentation requirements in He-E 803 and He-P 818, as well as He-E 801.33 (He-E 801.15).
• Providers must be enrolled in NH Medicaid as a CFI provider and meet the licensing requirements for their service (He-E 801.32).
• Providers must keep an individual provider care plan and documentation for each participant (He-E 801.32).
• Providers must check the names of prospective and current employees, volunteers and subcontractors against the state registry under RSA 161-F:49, and report suspected abuse, neglect or exploitation (He-E 801.32).

Medicaid funding for adult day in New Hampshire

The Choices for Independence program provides long-term services and supports under Section 1915(c) of the Social Security Act (He-E 801.02). Participants must be financially eligible for Medicaid and meet the clinical eligibility requirements for nursing facility care in RSA 151-E:3, I(a). A case manager from a case management agency licensed under He-P 819 develops a comprehensive care plan and requests authorization from DHHS for the services in it (He-E 801.05).

CFI covers adult day services for non-acute needs. Covered services include supervision, personal care, monitoring of health conditions, counseling on diet and hygiene, referrals, and the health and safety, dietary, nursing, social, rehabilitative and recreational services described in He-P 818. CFI does not cover adult day for a participant who receives residential care facility services or adult family care.

Separately, He-E 803 describes the eligibility requirements for people seeking adult medical day services reimbursed under Medicaid and the program requirements for providing them.

Billing basics

CFI providers submit all initial claims to the Medicaid fiscal agent so that it receives them no later than one year from the earliest date of service, and a rejected claim can be resubmitted within 15 months of that date. Payment follows rates established by DHHS, and a provider may not bill the participant when Medicaid denies payment because of the provider's billing practices (He-E 801.34). Services are authorized through the participant's comprehensive care plan.

The CFI rule ties electronic visit verification (EVV) to documentation of personal care services (He-E 801.33). It does not apply EVV to adult day services.

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

• He-P 800, Residential Care and Health Facility Rules (includes He-P 818, Adult Day Programs)
• He-P rules index with He-P 818 section list
• He-E 800, Medical Assistance (includes He-E 801 and He-E 803)
• DHHS Adult and Aging Care

Frequently asked questions

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

Yes. New Hampshire licenses adult day programs under RSA 151 and He-P 818, and CFI pays for adult day only when it is delivered by a licensed ADP.

Does New Hampshire Medicaid pay for adult day care?

Yes. The Choices for Independence waiver covers adult day services for eligible participants with an authorized care plan, and He-E 803 governs adult medical day services reimbursed under Medicaid.

Who inspects adult day centers in New Hampshire?

DHHS licenses adult day programs, and its He-P 818 rule includes a dedicated inspections section (He-P 818.09). Programs that serve CFI participants must also meet the CFI provider requirements in He-E 801.32.