Adult Day Care Regulations in Rhode Island

Who regulates adult day care in Rhode Island

The Rhode Island Department of Health (RIDOH) licenses adult day care programs under 216-RICR-40-10-7, Licensing Adult Day Care Programs, issued under R.I. Gen. Laws 23-1-52(a). No one may establish, conduct or maintain an adult day care program without a license. The rule applies to all adult day care programs that serve the elderly, which it defines as people 55 or older.

Medicaid coverage is run by the Executive Office of Health and Human Services (EOHHS), which lists adult day care among Medicaid home and community-based services. The Office of Healthy Aging (OHA) runs a state cost-share program that also helps pay for adult day.

Types of adult day programs in Rhode Island

• Adult day care program: the rule defines this as a comprehensive, nonresidential program designed to address the biological, psychological and social needs of adults, offering individual care plans and support services in a protective setting.
• Alzheimer or other dementia special care services program: any program that offers services to one or more participants with a diagnosis of Alzheimer dementia or other dementia. These programs must meet added requirements described below.

How to get licensed in Rhode Island

1. Apply to RIDOH on the Department's forms. RIDOH may issue a license when the applicant meets the statute and the rule.
2. Expect inspections. RIDOH sets how often it inspects, and its representatives may enter without prior notice. Refusing an inspection is grounds for suspension or revocation.
3. Renew on time. A license expires March 31 of each odd-numbered year and may be renewed on application.
4. Plan ahead for ownership changes. A license cannot be transferred without written RIDOH approval, it expires when ownership changes, and a new owner must apply for a new license before operating.
5. To serve Medicaid members, note that the EOHHS home and community-based services manual requires in-state providers to be licensed or certified by Rhode Island.

Key requirements

Under 216-RICR-40-10-7 (periodic refile effective January 4, 2022, with no text changes), a program must have:

• A full-time program director, with the director or a designee on site during operating hours.
• A nurse on site daily for at least six hours, at least one nursing assistant licensed by RIDOH, and an activities director on site daily for at least four hours.
• Case management on site, or available at least 20 hours a week, when daily enrollment is 24 or more.
• At least one staff member trained in first aid and CPR on site during all operating hours, and enough qualified staff to meet participants' needs. The rule sets no numeric staff ratio.
• A written plan for at least ten hours of staff training and development.
• At least 51 percent of average daily participants who are 55 or older.
• A pre-admission assessment, a notice from the applicant's primary care physician before acceptance, and a written plan of care within 30 days.
• A noon meal and two snacks for each full day of attendance, and separate, identifiable space for program activities during operating hours.

Dementia special care programs must also file a standard disclosure form with RIDOH and keep at least one registered nurse on staff and available for consultation at all times. New employees who assist with personal care at the dementia level need at least 12 hours of orientation and training, and the program must provide a secure environment with elopement policies.

Medicaid funding for adult day in Rhode Island

Rhode Island Medicaid covers adult day care as a home and community-based service. The EOHHS HCBS Provider Reference Manual (version 1.12, December 2024) cites the Rhode Island Comprehensive 1115 Demonstration as the authority for these services. EOHHS reports that the Medicaid 1115 Demonstration Waiver runs from January 1, 2026 through December 31, 2030.

The manual lists adult day care under several eligibility programs, including LTSS home and community-based services (Core Community Services), Shared Living, Habilitation Community Services, Self-Direction Community Services and Medicaid Preventive Services. LTSS recipients may owe a share of the cost.

Billing basics

The HCBS manual lists HCPCS code S5102 for adult day care; a manual update corrected an earlier listing of S5120. It shows 15-minute units for LTSS home and community-based services and OHA Core Community Services, and a per diem unit for Shared Living and the OHA At Home Cost Share program. S5102 is a per diem code in HCPCS, so confirm the billing unit on the EOHHS fee schedule before billing. Claims should be billed electronically, and paper claims use the Waiver/Rehab or CMS-1500 form.

Other ways centers are paid

OHA's At HOME Cost Share program shares the cost of in-home and community adult day services for adults 65 and older, and for people ages 19 to 64 with Alzheimer's disease or a related dementia, with income at or below 250 percent of the federal poverty level. Participants pay a share based on income, and the HCBS manual says this program is for people who are not eligible for Medicaid and requires prior authorization from OHA. Enrolled veterans who meet VA eligibility and clinical criteria can get adult day health care through the VA (VA Adult Day Health Care).

Official resources

• 216-RICR-40-10-7, Licensing Adult Day Care Programs
• EOHHS Medicaid Provider Manual: Home and Community Based Services
• EOHHS Medicaid State Plan and 1115 Waiver
• Office of Healthy Aging: Adult Day Health Centers
• Office of Healthy Aging: At HOME Cost Share

Frequently asked questions

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

Yes. Under 216-RICR-40-10-7, no one may establish, conduct or maintain an adult day care program serving the elderly without a RIDOH license. Licenses expire March 31 of each odd-numbered year and may be renewed.

Who inspects adult day centers in Rhode Island?

RIDOH. It sets the inspection schedule, and its representatives may enter without prior notice.

Does Rhode Island Medicaid pay for adult day care?

Yes. EOHHS lists adult day care, billed under HCPCS S5102, among Medicaid home and community-based services authorized by the Rhode Island Comprehensive 1115 Demonstration. OHA's At HOME Cost Share program helps people who are not eligible for Medicaid.

Are there special rules for dementia programs?

Yes. Alzheimer or other dementia special care programs must file a disclosure form, keep a registered nurse on staff and available for consultation at all times, give new personal care staff at least 12 hours of orientation and training, and provide a secure environment.