Adult Day Care Regulations in New York

Who regulates adult day care in New York

The New York State Department of Health (DOH) approves medical model adult day health care (ADHC) programs under 10 NYCRR Part 425. A program is listed on the operating certificate of a licensed residential health care facility (a nursing home or a facility providing health-related service, under Public Health Law section 2801) or runs at an approved extension site.

Social adult day care (SADC) follows 9 NYCRR 6654.20. The New York State Office for the Aging (NYSOFA) sets monitoring requirements that area agencies on aging apply to programs they fund. SADCs that contract with Managed Long Term Care (MLTC) plans must certify compliance each year through the Office of the Medicaid Inspector General (OMIG), and the DOH SADC HCBS Compliance program checks them against the federal home and community-based services (HCBS) settings rule. In New York City, every SADC must register with NYC Aging before operating.

Types of adult day programs in New York

• Adult day health care (ADHC): health care services and activities in a non-residential group setting for registrants with functional impairments, to help them remain in the community.
• Social adult day care (SADC): a structured program that gives functionally impaired individuals socialization, supervision and monitoring, personal care and nutrition in a protective setting for less than 24 hours a day.

How to get licensed in New York

For ADHC, the proposed operator must apply for and receive DOH approval under 10 NYCRR Part 710 before operating (section 425.2). The application describes need, services, space, staffing, budget and evaluation methods. Extension sites need Part 710 approval, and changes to space, services or registrant capacity go to DOH in writing under Part 710 (section 425.3).

For SADC:

• In New York City, register each location with the NYC Aging SADC Ombuds Office before operating. NYC Aging states that registration is not a license or certification.
• To contract with an MLTC plan, complete the OMIG SADC certification for each location and renew it every 12 months (MLTC Policy 15.01(a)).
• Under MLTC Policy 25.05 (effective September 8, 2025), plans must require a site-level organization NPI for each SADC location (taxonomy 261QA0600X) and verify a current certificate of occupancy before network enrollment and annually.

Key requirements

Adult day health care (Part 425, revised effective March 20, 2024):

• Each session lasts at least five hours, not counting transportation, with at least one meal plus snacks and hydration.
• Required services include case management, nursing, nutrition, social services, help with daily living activities, rehabilitation therapy, activities, pharmaceutical services and dental referrals.
• Nursing is directed by a registered professional nurse on-site during all hours of operation. Based on registrants' care needs, a licensed practical nurse may provide the on-site services under RN supervision.
• Registrants must need at least one visit per week, and the person-centered care plan is due within five visits or 30 days, whichever is earlier, with review at least every six months.
• Settings must meet HCBS rules, including community access, privacy, meals and snacks at any time, and unrestricted visitors.

Social adult day care (9 NYCRR 6654.20):

• Serve only functionally impaired individuals: people who need help with at least one of toileting, mobility, transferring or eating, or need supervision due to cognitive or psycho-social impairment.
• Keep at least two staff, one of them paid, with participants during the program day, and have a paid director.
• Complete a self-evaluation at least annually. For MLTC members, Policy 25.05 also requires a person-centered service plan within 30 days of admission.

Medicaid funding for adult day in New York

New York Medicaid covers adult day mainly through MLTC, which DOH lists among the programs operating under its Section 1115 Demonstration Waiver (effective through March 31, 2027). The DOH MLTC overview lists adult day health care as a capitated service and social day care as a service provided through care management. Enrollment is mandatory, unless excluded, for dual-eligible adults 21 and older who need community-based long term services for more than 120 days and meet the assessment criteria.

Plan payment for ADHC follows the negotiated agreement between the program and the plan, and the plan may order less than the full range of services (section 425.24). ADHC rates also appear in the State Medicaid Plan (CMS-approved amendment 09-13), and 10 NYCRR 86-2.9 sets the rate method for ADHC in residential health care facilities.

Billing basics

DOH requires universal billing codes for claims under contracts between long term care providers and managed care plans (December 2017 letter, supplemented in August 2024):

• S5102: full range adult day health care, per diem, with no modifier for programs that do not elect the Unbundled Services/Payment Option.
• S5102 with U1, U2 or U3: basic, standard or intensive level ADHC, per diem, for programs using that option.
• S5105: social adult day care, per diem.

Section 425.24 limits billing to one visit per registrant per day. The majority of registrants paid for by a government agency must attend at least five hours.

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

• 10 NYCRR Part 425, Adult Day Health Care
• 9 NYCRR 6654.20, Social Adult Day Care Programs
• DOH SADC HCBS Compliance
• DOH Overview of Managed Long Term Care
• OMIG SADC Certification
• New York State Office for the Aging
• NYC Aging: Social Adult Day Care
• Adult Day Health Care Council (LeadingAge New York)

Frequently asked questions

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

For adult day health care, yes: you need DOH approval under Parts 425 and 710 before operating. Social adult day care follows 9 NYCRR 6654.20, with New York City registration and OMIG certification for MLTC contracts.

Does New York Medicaid pay for adult day care?

Yes. Medicaid covers adult day health care mainly through MLTC plans, and social day care only through MLTC plans, which pay centers under their contracts.

Is social adult day care regulated in New York?

Yes. 9 NYCRR 6654.20 sets the standards, area agencies on aging monitor programs they fund, MLTC plans evaluate contracted SADCs, and DOH reviews HCBS compliance. In New York City, NYC Aging registers programs and makes unannounced visits.