Adult Day Care Regulations in Virginia

Who regulates adult day care in Virginia

The Virginia Department of Social Services (VDSS) Division of Licensing Programs licenses adult day centers under 22VAC40-61, Standards and Regulations for Licensed Adult Day Centers. The rules were last amended effective August 14, 2024.

The Department of Medical Assistance Services (DMAS) runs Virginia Medicaid, called Cardinal Care, which pays for adult day health care (ADHC).

Types of adult day programs in Virginia

Under 22VAC40-61-10, an adult day center is a facility that is operated for profit or that seeks licensure and provides supplementary care and protection for part of the day to four or more adults who are aged, infirm or have disabilities and live elsewhere. Sites controlled by one entity count together. Facilities licensed by the State Board of Health or the Department of Behavioral Health and Developmental Services, and homes caring only for relatives, are excluded.

Virginia has one license for adult day centers, whether the program is social or health focused. Adult day health care is a Medicaid service that must be delivered in a VDSS-licensed center (12VAC30-120-924).

How to get licensed in Virginia

1. Watch VDSS's two training videos in order: Introduction to Licensing, then Introduction to Adult Day Centers.
2. Prepare the Initial Application Form, ADC Program Addendum, ADC Staff Information Form, annual operating budget, environmental sanitation inspection report and request for building evaluation or inspection.
3. Complete comprehensive background checks. The Virginia State Police run criminal history reports, and VDSS's background check regulation for adult day centers took effect August 15, 2025.
4. Submit your initial application through VELA, the Virginia Enterprise Licensing Application, as described on the Apply for Licensure page. Data cannot be revised after submission.
5. Give VDSS a reasonable opportunity to inspect your facility, as state law requires of applicants.

Licenses run for six months, one, two or three years. Under Code of Virginia § 63.2-1706, a center with a one-year license gets at least three inspections a year, two unannounced, while a three-year license brings at least one unannounced inspection a year.

Key requirements

• Minimum staff: at least two staff on duty at the center and on field trips whenever participants are present (22VAC40-61-190).
• Ratio: at least one direct care staff person for every six participants, or portion thereof, calculated for the whole center (22VAC40-61-200).
• Director: at least 21, with a bachelor's degree plus two years of experience with older adults or people with disabilities, a nursing home or assisted living administrator license, or an RN license plus two years of experience. The director or a qualified assistant must be present at least 51% of weekly hours (22VAC40-61-130).
• Health supervision: centers must continually observe participants for health changes. The licensing rule does not require an on-site nurse (22VAC40-61-280).
• Space: at least 50 square feet of indoor space per participant for centers licensed after July 1, 2000, not counting hallways, offices, bathrooms or storage (22VAC40-61-440).
• Medicaid ADHC: providers also need an RN on site at least eight hours a month and available whenever the center is open, an activities director and an ADHC coordinator (12VAC30-120-935).

Medicaid funding for adult day in Virginia

ADHC is a service of the Commonwealth Coordinated Care Plus (CCC Plus) Waiver, a 1915(c) waiver for people who meet nursing facility level of care criteria and are at imminent risk of nursing facility placement. A day of ADHC is at least six hours, and Medicaid does not pay for it for people living in nursing facilities, intermediate care facilities for individuals with intellectual disabilities, hospitals, assisted living facilities or DBHDS-licensed group homes.

All Medicaid members are part of Cardinal Care. As of July 1, 2025, the managed care plans are Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons of Virginia, Sentara Health Plans and UnitedHealthcare Community Plan; confirm current plans with DMAS. DMAS or its contractor authorizes waiver services for fee-for-service members, and the member's plan handles authorization for managed care members.

Billing basics

DMAS's CCC Plus Waiver billing chapter (updated February 2024) lists S5102 for Adult Day Health Care Services, billed per diem, and A0120 for ADHC transportation, billed per trip. Attendance of six hours or more is a day; less than six hours is a half day, and half days may be added and rounded to whole days at month end.

Fee-for-service claims go to DMAS on the CMS-1500 or as 837P transactions, by EDI or direct data entry in the MES Provider Portal. For managed care members, you must be credentialed with the member's plan and follow its claims instructions. The EVV section of the waiver manual covers personal care and respite, not ADHC.

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

• VDSS Adult Day Centers
• VDSS Apply for Licensure
• 22VAC40-61: Standards and Regulations for Licensed Adult Day Centers
• 12VAC30-120-935: CCC Plus Waiver Participation Standards
• CCC Plus Waiver Fact Sheet
• DMAS Cardinal Care

Frequently asked questions

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

Yes, if you operate for profit and provide part-day care to four or more adults who are aged, infirm or have disabilities. Nonprofit programs fall under the rule when they seek licensure, and Medicaid ADHC requires a VDSS license.

Does Virginia Medicaid pay for adult day care?

Yes. Adult day health care is a CCC Plus Waiver service paid per diem by DMAS for fee-for-service members or by the member's Cardinal Care managed care plan.

Who inspects adult day centers in Virginia?

VDSS licensing inspectors. The number of required inspections, including unannounced visits, depends on the length of the center's license.

Is social adult day care regulated in Virginia?

Yes. VDSS uses one adult day center license for social and health-focused programs that meet the definition, and the licensing rule does not require an on-site nurse.