Adult Day Care Regulations in Vermont

Who regulates adult day care in Vermont

Vermont oversees adult day centers through certification. The Adult Services Division (ASD) of the Department of Disabilities, Aging and Independent Living (DAIL) is responsible for certifying adult day centers, using the Standards for Adult Day Services in Vermont (revised January 2017).

Certification is required to provide services through the Department, and the standards say it also meets the federal Medicaid criterion that a center be state certified.

Types of adult day programs in Vermont

The standards define adult day services as community-based, non-residential services for adults with physical or cognitive impairments, with no separate social and medical categories. Every certified center must offer the same core services:

• Health coordination and chronic disease management, monitored by the staff registered nurse (RN).
• Direct care: help with and supervision of activities of daily living, supervised by an RN or licensed practical nurse.
• Social work services and therapeutic activities.
• Nutrition and food services, including at least one meal a day.
• Transportation, when feasible.

How to get certified in Vermont

1. Notify DAIL that you intend to open a center, and submit information on unmet need, community support, transportation, budget, program design and space (Section II.A).
2. DAIL consults the Vermont Association of Adult Day Services, then schedules an on-site review that rates each standard as met or unmet. If any standard is unmet, the application is denied, and you may correct the issues and reapply.
3. Initial certification of a new center lasts no more than one year.
4. After that, DAIL may certify a center for up to three years: three years with no significant deficiencies, two years with minor deficiencies, and one year when a corrective action plan is required. DAIL may also make unannounced visits at any time.
5. To serve Choices for Care participants, submit ASD's adult day provider enrollment application. If DAIL approves it, you then file a Medicaid provider enrollment application with the state's Medicaid fiscal agent.

Key requirements

• Staffing ratio: at least one direct services staff member for every seven participants, with more staff as participants' impairments increase (Section V.C.2).
• Administrator: a master's degree with one year of supervisory experience, or a bachelor's degree with three years of supervisory experience in a social or health setting (Section V.B.1).
• Registered nurse: the staff RN, who monitors health coordination and chronic disease management, needs a current Vermont RN license and at least one year of applicable experience (Sections V.B.3 and X).
• Training: at least 12 hours a year for direct service staff (Section VI.F.2).
• Space: at least 60 square feet of program space per participant and at least one toilet for every 10 participants (Section XII.G.4).
• Hours: services at the primary site at least five days a week, nine hours a day (Section XII.A.2).

Medicaid funding for adult day in Vermont

Choices for Care (CFC) is DAIL's long-term services and supports program. Its program regulations (April 2020) say it operates within Vermont's Global Commitment to Health Section 1115 waiver, and they define adult day services as health and social services provided at a location certified by DAIL.

The High and Highest Needs groups serve Vermonters who need nursing home level of care and meet clinical and financial eligibility for long-term care Medicaid. They can receive up to 12 hours of adult day a day. The Moderate Needs Group covers adult day, homemaker, case management and flexible funds for people who do not meet nursing home level of care, with adult day capped at 50 hours a week. Moderate Needs participants do not need to be Medicaid eligible, but funding is limited.

ASD's rate sheets also list Day Health Rehabilitation Services, a Global Commitment service paid from the DAIL budget.

Billing basics

DAIL authorizes CFC services and notifies participants of the amount and start date. Under the CFC High/Highest Program Manual (revised July 2020), the DAIL-approved Service Plan authorizes a provider to deliver services and submit claims, and adult day is limited to the hours on that plan.

ASD's SFY2027 Medicaid rate sheet lists four adult day revenue codes (the sheet shows no procedure code), each billed in 15-minute units:

• 078: home-based waiver adult day service (CFC).
• 084: respite provided by an adult day service provider (CFC).
• 096: adult day for the CFC Moderate Needs Group.
• 99: Adult Day Health Services under Global Commitment, listed as Day Health Rehabilitation Services in the April 2026 sheet.

DVHA's electronic visit verification (EVV) page says EVV applies to in-home services funded by Vermont Medicaid, such as in-home personal care. It does not mention adult day.

Other ways centers are paid

DAIL's Dementia Care and Family Caregiver Support programs include Dementia Respite Grants and the National Family Caregiver Program, which Vermont's five Area Agencies on Aging manage. The grants can pay for a range of services, and DAIL lists adult day among them.

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

• DAIL Adult Services Division
• Standards for Adult Day Services in Vermont (January 2017)
• ASD Agency Certification Standards
• ASD Provider Enrollment
• Choices for Care Program Regulations (2020)
• Choices for Care High/Highest Program Manual
• Choices for Care Moderate Needs Services
• ASD State Fiscal Year 2027 Medicaid Rates
• Dementia Care and Family Caregiver Support

Frequently asked questions

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

Vermont uses certification. DAIL's Adult Services Division certifies adult day centers under the Standards for Adult Day Services in Vermont, and certification is required to provide services through the Department, including Choices for Care.

Is social adult day care regulated in Vermont?

The standards do not set up a separate social adult day category. Every certified center must provide the same core services, including health coordination monitored by a staff RN.

Does Vermont Medicaid pay for adult day care?

Yes. Choices for Care, which operates within the Global Commitment to Health 1115 waiver, covers adult day for eligible High, Highest and Moderate Needs participants. ASD's rate sheets also list Day Health Rehabilitation Services under Global Commitment.

Who inspects adult day centers in Vermont?

DAIL conducts the on-site certification review, may hold an announced review each year, and may make unannounced visits at any time.