Adult Day Care Regulations in Oregon

Who regulates adult day care in Oregon

Oregon does not license adult day programs. The Oregon Department of Human Services (ODHS), Aging and People with Disabilities (APD) keeps a registry of adult day programs and sets standards that programs follow voluntarily, as required by ORS 410.485 to 410.495.

The standards become mandatory when a program wants Medicaid funding. Under OAR chapter 411, division 066, adult day programs that enroll with APD to provide services must be certified. APD conducts the certification visits and may review programs unannounced.

Types of adult day programs in Oregon

Oregon uses one program type, the Adult Day Services (ADS) program. The rules define it as a community-based group program designed to meet the needs of adults with functional impairments. State law describes adult day care as group programs for adults with functional or cognitive impairments that provide care for part of the day, but less than 24-hour care.

Under these rules, a program can be in one of three positions:

• Not registered: the rules place programs on the registry only when they voluntarily provide the required information.
• Registered programs: have given APD their name, address and a checklist showing how far they comply with the standards.
• Certified programs: have passed APD certification and can enroll as Medicaid providers.

How to get certified in Oregon

Registration is optional. To join the registry, send APD your program's name and address and the compliance checklist described in OAR 411-066-0010.

To serve Medicaid participants, follow the certification steps in OAR 411-066-0015:

1. Contact APD to schedule an initial on-site visit.
2. Provide a cover letter detailing your qualifications as an adult day program.
3. Complete the ADS certification self-assessment.
4. Participate in a follow-up on-site inspection by APD.
5. Enroll as a Medicaid provider with current certification, current business registration, the Adult Day Services Medicaid Provider Enrollment Application and Agreement, and the insurance the agreement requires. APD's Provider Enrollment Unit offers enrollment help.

Certification generally lasts up to two years (longer in limited cases under OAR 411-066-0015). Renewal requires a new self-assessment and on-site visit.

Key requirements

The standards in OAR 411-066-0020 were last amended effective February 15, 2019. Key provisions include:

• Staffing ratio: at least one staff person to six participants, or one to four when over 50 percent of participants need full assistance with three or more activities of daily living.
• Program director: at least 21, with a bachelor's degree in health care or management, or a high school diploma plus two years of professional or management experience in the past five years.
• Space: at least 60 square feet of common floor space per participant, or 80 square feet if 25 percent or more of participants are cognitively impaired or use adaptive equipment, plus at least one toilet per 10 participants.
• Medications: if medication services are offered, a written medication policy approved by a registered nurse or pharmacist and a secured storage area.
• Background checks: criminal history and abuse checks under OAR 407-007, repeated every two years for all staff and volunteers.
• Safety and services: someone trained in first aid and CPR on site whenever participants are present, and at least one meal when participants attend at a typical mealtime.

Medicaid funding for adult day in Oregon

ODHS pays certified programs directly. The payment rule, OAR 411-027-0020 (last amended 2018), covers adult day services and limits payments to services under Oregon's Medicaid State Plan K Option for people served through APD.

Oregon Project Independence-Medicaid (OPI-M), which operates under an 1115 demonstration waiver, also covers adult day services. Under rules effective November 22, 2024, the OPI-M case manager authorizes and monitors adult day services in the service plan, and the person's in-home hours are reduced by the hours spent at the program.

Billing basics

ODHS or Area Agency on Aging local office staff must authorize adult day services before payment. ODHS pays a half day when four or fewer hours of services are provided, and a full day when more than four but less than 24 hours are provided. Rates come from the APD rate schedule.

Certified programs use the Medicaid Performing Provider Number assigned at enrollment for billing and payment. Adult day services are not paid if another provider is already authorized for the same service.

Oregon's EVV fact sheet (March 2020) addresses personal care and home health services and does not mention 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

• ODHS APD Provider and Partner Resources
• OAR 411-066: Adult Day Services Programs
• OAR 411-027: Payment Limitations in Home and Community-Based Services
• OAR 411-016: Oregon Project Independence-Medicaid
• ORS Chapter 410: Adult Day Care Service
• ODHS APD Rules and Rulemaking

Frequently asked questions

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

No state adult day license exists. Registration with APD is voluntary, but you must be certified by APD to enroll as a Medicaid provider.

Does Oregon Medicaid pay for adult day care?

Yes. ODHS pays certified programs for authorized adult day services by the half day or full day under OAR 411-027-0020, which ties these payments to the State Plan K Option, and under Oregon Project Independence-Medicaid.

Who inspects adult day centers in Oregon?

ODHS APD inspects programs that seek Medicaid certification, through initial and renewal on-site visits, and may conduct unannounced reviews during the certification period.

Is social adult day care regulated in Oregon?

Only through the voluntary registry and Medicaid certification. State law describes the standards as voluntary, and certification is required for programs that enroll as Medicaid providers.