Adult Day Care Regulations in West Virginia

Who regulates adult day care in West Virginia

West Virginia licenses medical adult day care centers under legislative rule 64CSR2, Licensure of Medical Adult Day Care Centers, effective July 1, 2009. The Office of Health Facility Licensure and Certification (OHFLAC) handles license applications through its Assisted Living Program.

On the Medicaid side, the Bureau of Senior Services operates the Aged and Disabled Waiver (ADW) under the supervision of the Bureau for Medical Services (BMS), West Virginia's Medicaid agency.

Types of adult day programs in West Virginia

Under 64CSR2 § 3, a medical adult day care center is an ambulatory health care facility that provides an organized day program of therapeutic, social, health maintenance and restorative services. Its goal is to offer an alternative to 24-hour institutional care for elderly or disabled adults with physical and mental impairments.

The rule covers any operator, for profit or not, including day programs run by nursing homes and hospitals. It does not apply to adult day programs that are primarily social and recreational, even if they occasionally offer medical screening clinics (64CSR2 § 2).

How to get licensed in West Virginia

1. Check whether your project needs certificate of need review. If it does, the license will not be issued without a finding that the project conforms to the certificate of need decision.
2. Submit OHFLAC's medical adult day care license application and fee at least 90 days before opening. Include a notarized signature, a preliminary operating plan with a budget and balance sheet, the director's proof of education, background check cards, a staffing chart and certificate of need verification.
3. Pass at least one inspection, which happens after the application is complete and the center is ready.
4. Receive a license for up to one year. Licenses end by June 30 after issuance, and renewals are due at least 90 days before expiration.

Licenses cannot be transferred, and the state makes unannounced inspections at least once every 12 months (64CSR2 § 4).

Key requirements

• Director: at least 21, with two years of post-secondary education, or a high school diploma plus at least five years of social service or health care experience with elderly or disabled adults, two of them supervisory. The director or a designated employee must be in charge at all times (64CSR2 § 6).
• Nursing: employ or contract with a West Virginia-licensed RN who is in the center at least eight hours a week. A nurse must be on duty during primary hours and on call otherwise.
• Staffing ratio: at least one full-time direct service staff member for every six participants. Volunteers count only if professionally trained or certified in a health occupation.
• Training: orientation within the first 14 days and annually, including two hours on Alzheimer's disease and related dementias, plus first aid and CPR certification for all employees.
• Screening: check abuse and nurse aide registries before hiring, and do not hire or keep anyone listed.
• Incidents: report major incidents to the licensure office by the next business day.
• Facility: a rest area with at least one bed and one recliner, and indoor temperatures between 72 and 80 degrees (64CSR2 § 13).

Medicaid funding for adult day in West Virginia

West Virginia Medicaid pays for medical adult day care through the ADW, a 1915(c) waiver for people 18 or older who meet financial rules and are approved for nursing home level of care. The state added the service through a waiver amendment with a proposed effective date of February 1, 2024.

The BMS ADW provider manual (effective June 1, 2026) lists adult medical daycare under both the Traditional and Personal Options models. Acentra Health is the ADW utilization management contractor, and BMS directs providers to its fiscal agent for prior authorization requirements and service limits.

Billing basics

The ADW code set effective October 1, 2024 lists Adult Day Care as T2021 with modifier U4 for a full day of 7 or more hours and T2021 with modifier U8 for a half day of 4 hours or less. The two codes share a limit of 261 per year. Confirm current codes and claim rules with BMS before billing.

The manual's electronic visit verification (EVV) section names personal attendant care as a service that uses EVV and does not mention adult medical day care.

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

• Office of Health Facility Licensure and Certification
• License Application for Medical Adult Day Care
• 64CSR2: Licensure of Medical Adult Day Care Centers
• Aged and Disabled Waiver
• BMS Provider Manual Chapter 501: Aged and Disabled Waiver
• ADW Code Set

Frequently asked questions

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

You need a license to operate a medical adult day care center under 64CSR2. Programs that are primarily social and recreational are exempt from that rule.

Does West Virginia Medicaid pay for adult day care?

Yes. The Aged and Disabled Waiver covers medical adult day care, billed as full or half days under procedure code T2021.

Who inspects adult day centers in West Virginia?

OHFLAC licenses medical adult day care centers. The rule requires an inspection before the first license and unannounced inspections at least once every 12 months.

Is social adult day care regulated in West Virginia?

64CSR2 does not apply to adult day programs that are primarily social and recreational. No other licensing rule for those programs was identified for this guide.