Adult Day Care Regulations in Oklahoma

Who regulates adult day care in Oklahoma

The Oklahoma State Department of Health (OSDH) licenses adult day care centers under the Adult Day Care Act, which starts at 63 O.S. 1-870. OSDH's Long Term Care Service conducts licensure and complaint investigations in adult day care centers.

The licensing standards are in Oklahoma Administrative Code (OAC) 310:605, Adult Day Care Centers. Medicaid coverage of Adult Day Health is set by Oklahoma Health Care Authority (OHCA) rules for the ADvantage program waiver.

Types of adult day programs in Oklahoma

Under 63 O.S. 1-872, an adult day care center is a facility that provides basic day care services to unrelated impaired adults for more than four hours in a 24-hour period. Basic day care services are supervised health, social supportive and recreational services in a structured daytime program for functionally impaired adults who live in their own homes.

A center must be a distinct entity, either freestanding or a separate program of a larger organization, with separately verifiable staff, space, budget and participant records. The definition excludes retirement centers, senior citizen centers and PACE organizations. Sheltered workshops and senior recreational centers that do not receive participant fees for services do not need a license.

How to get licensed in Oklahoma

1. File an application on a form approved by OSDH and pay the initial license fee. Include evidence of compliance with applicable federal, state and local laws, an ownership statement and a financial statement (63 O.S. 1-874).
2. License each site. Organizations operating more than one center need a license for each site, and a license covers only the premises named in the application and cannot be transferred (OAC 310:605-5-1).
3. Prepare for inspection. OSDH inspects each center at least annually and whenever it deems necessary, and refusing entry may be grounds for denial or revocation (63 O.S. 1-875).
4. Renew on time. An initial license expires 180 days after issuance, a regular license expires 36 months after issuance, and renewal applications are due at least 45 days before expiration.

Operating an adult day care center without a current license is unlawful, regardless of other licenses the operator holds. The license must be posted in a conspicuous place.

Key requirements

• Staffing ratio: At least one full-time-equivalent direct care staff person for every eight participants present, plus one more for a major portion of eight more. Whenever participants are present, at least two responsible persons must be at the center, and one must be a staff member (OAC 310:605-11-2).
• Required staff: A director, an activity director, a social services coordinator or case manager and a dietary supervisor, with nurses, therapists and drivers as needed (OAC 310:605-11-1).
• Medications: Only an RN, LPN, certified medication aide or medication administration technician may administer them. When aides or technicians do, an RN or LPN must consult monthly (OAC 310:605-11-1).
• Qualifications: The director needs a bachelor's degree and one year of supervisory experience in a social or health services setting, or a high school diploma and five consecutive years of supervisory experience in long-term care or geriatrics. Aides who give personal care need at least adult day care level nursing aide certification (OAC 310:605-11-3).
• Services: Planned activities for at least half of daily operations, with a minimum of four hours, at least one meal daily that provides one-third of the recommended dietary allowance, and at least one CPR-trained staff person on duty at all times (OAC 310:605-13-1).
• Space: At least 40 square feet per participant, not counting hallways, storage areas, offices, restrooms and kitchens (OAC 310:605-15-3).

Most of the staffing and service rules were last amended effective May 27, 2003. The license rule in OAC 310:605-5-1 was amended effective September 11, 2022.

Medicaid funding for adult day in Oklahoma

OHCA rules list Adult Day Health (ADH) as an ADvantage program waiver service. Under OAC 317:30-5-763, ADH is furnished on a regularly scheduled basis for one or more days per week in an outpatient setting and provides health and social services. Help with activities such as eating, mobility, toileting and nail care is covered by the basic ADH reimbursement rate.

Members who attend four or more hours a day receive one meal with at least one-third of the daily recommended dietary intake. Bathing, hair care or laundry can be billed separately as a personal care enhancement, and physical, occupational and speech therapy can be billed as a therapy enhancement, each only when the service plan authorizes it.

ADH centers must also meet home and community-based settings standards, including being integrated in and supporting access to the broader community. The rule says the center must ensure members' rights of privacy, dignity, respect and freedom from coercion and restraint, and members control their own schedules, activities and access to food.

Billing basics

ADvantage ADH is billed in 15-minute units. No more than eight hours (32 units) are authorized per day, and billing is limited to the units approved on the member's service plan (OAC 317:30-5-763). Personal care and therapy enhancements are separate procedures, each limited to one unit or session per day. The sources reviewed for this guide did not confirm procedure codes, claim format or whether EVV applies, so check current OHCA billing guidance before you bill.

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

• OSDH: Long Term Care Service
• OSDH: Long Term Care Rules, Regulations and Statutes
• Adult Day Care Act (OSDH)
• OAC 310:605: Adult Day Care Centers
• OAC 317:30-5, Part 85: ADvantage Program Waiver Services
• VA Adult Day Health Care

Frequently asked questions

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

Yes. It is unlawful to operate an adult day care center without a current OSDH license, and each site needs its own license. Sheltered workshops and senior recreational centers that do not receive participant fees are exempt.

Does Oklahoma Medicaid pay for adult day care?

Yes. OHCA rules cover Adult Day Health as an ADvantage program waiver service, billed in 15-minute units up to eight hours a day as approved on the member's service plan.

Who inspects adult day centers in Oklahoma?

OSDH. It inspects each center at least annually and whenever it deems necessary, and its Long Term Care Service handles licensure and complaint investigations.